OBJECTIVES: To study the transition time of patients with Type 2 diabetes mellitus (T2DM) progressing from “good” to “poor” glycemic control and its association with the number and type of diabetes-related vascular diseases such as coronary heart disease, stroke, eye complications, peripheral vascular disease, and nephropathy. METHODS: In this retrospective study, data from a disease registry were used. A cohort of T2DM patients who had attended either a hospital specialist clinic or a primary care diabetes service, and deemed to have “good” control (at least two consecutive HbA1c ≤ 7%) from October 2005 to March 2006 were included in this study. Patients were subsequently followed up for a period of 4 years. Time to “poor” glycemic control (HbA1c > 8%) for each diabetes-related vascular disease was calculated using Kaplan-Meier analysis. Hazards Ratio (HR) was adjusted for age, gender, ethnicity, BMI, duration of diabetes, baseline HbA1c, LDL-cholesterol and insulin use using Multivariate Cox analysis. RESULTS: There were 7739 T2DM patients, with median age of 68 years and baseline HbA1c of 6.4%. Over a quarter (28.9%) of patients reached “poor” control at the end of 4 years, with a median time of 575 days (95% CI: 550-600). Multivariate Cox regression analysis suggested that likelihood of “poor” control was increased with each additional diabetes-related vascular disease (AdjHR 1.14, 95% CI: 1.07-1.23) and higher for eye complications (AdjHR 1.47, 95%CI: 1.17-1.86) and nephropathy (AdjHR 1.43, 95% CI:1.06-1.93). CONCLUSIONS: Despite starting with “good” glycemic control, 3 out of 10 T2DM patients progressed to “poor” glycemic control at the end of 4 years of study. Patients with more diabetes-related vascular diseases were at higher risk of progressing to “poor” control, particularly those with microvascular complications.
Lim, B., Jong, M., & Toh, M. (2010). PDB24 VASCULAR DISEASES AND DURABILITY OF GOOD GLYCEMIC CONTROL IN PATIENTS WITH TYPE 2 DIABETES MELLITUS. Value in Health, 13(7), A530. https://doi.org/10.1016/s1098-3015(11)73199-0