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Distinct trajectories of HbA 1c in newly diagnosed Type 2 diabetes from the DPV registry using a longitudinal group‐based modelling approach
Author(s) -
Rathmann W.,
Schwandt A.,
Hermann J. M.,
Kuss O.,
Roden M.,
Laubner K.,
Best F.,
Ebner S.,
Plaumann M.,
Holl R. W.
Publication year - 2019
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.14103
Subject(s) - medicine , diabetes mellitus , type 2 diabetes , logistic regression , longitudinal study , prospective cohort study , hemoglobin a , endocrinology , pathology
Aim To identify groups of heterogeneous HbA 1c trajectories over time in newly diagnosed Type 2 diabetes. Methods The study comprised 6355 adults with newly diagnosed Type 2 diabetes (55% men, median age 62 years, baseline BMI 31 kg/m 2 ) from the Diabetes Patienten Verlaufsdokumentation ( DPV ) prospective multicentre diabetes registry (Germany, Austria). Individuals were assessed during the first 5 years after diabetes diagnosis if they had ≥ 3 aggregated HbA 1c measurements during follow‐up. Latent class growth modelling was used to determine distinct subgroups that followed similar longitudinal HbA 1c patterns ( SAS : Proc Traj). Multinomial logistic regression models were used to investigate which variables were associated with the respective HbA 1c trajectory groups. Results Four distinct longitudinal HbA 1c trajectory (glycaemic control) groups were found. The largest group (56% of participants) maintained stable good glycaemic control (HbA 1c 42–45 mmol/mol). Twenty‐six percent maintained stable moderate glycaemic control (HbA 1c 57–62 mmol/mol). A third group (12%) initially showed severe hyperglycaemia (HbA 1c 97 mmol/mol) but reached good glycaemic control within 1 year. The smallest group (6%) showed stable poor glycaemic control (HbA 1c 79–88 mmol/mol). Younger age at diabetes diagnosis, male sex, and higher BMI were associated with the stable moderate or poor glycaemic control groups. Insulin therapy was strongly associated with the highly improved glycaemic control group. Conclusions Four subgroups with distinct HbA 1c trajectories were determined in newly diagnosed Type 2 diabetes using a group‐based modelling approach. Approximately one‐third of people with newly diagnosed Type 2 diabetes need either better medication adherence or earlier intensification of glucose‐lowering therapy.