Changes in glycemic control from 1996 to 2006 among adults with type 2 diabetes: a longitudinal cohort study

Karen J Blumenthal,Mary E Larkin,David M Nathan,Richard W Grant,Gail Winning

doi:10.1186/1472-6963-10-158

Karen J Blumenthal, Mary E Larkin + Show 3 more

Open Access

https://doi.org/10.1186/1472-6963-10-158

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Abstract

BackgroundOur objectives were to examine temporal changes in HbA1c and lipid levels over a 10-year period and to identify predictors of metabolic control in a longitudinal patient cohort.MethodsWe identified all adults within our hospital network with T2DM who had HbA1c's measured in both 1996 and 2006 (longitudinal cohort). For patients with no data in 2006, we used hospital and social security records to distinguish patients lost to follow-up from those who died after 1996. We compared characteristics of the 3 baseline cohorts (longitudinal, lost to f/u, died) and examined metabolic trends in the longitudinal cohort.ResultsOf the 4944 patients with HbA1c measured in 1996, 1772 (36%) had an HbA1c measured in 2006, 1296 (26%) were lost to follow-up, and 1876 (38%) had died by 2006. In the longitudinal cohort, mean HbA1c decreased by 0.4 ± 1.8% over the ten-year span (from 8.2% ± 1.7% to 7.8% ± 1.4%) and mean total cholesterol decreased by 49.3 (± 46.5) mg/dL. In a multivariate model, independent predictors of HbA1c decline included older age (OR 1.41 per decade, 95% CI: 1.3-1.6, p < 0.001), baseline HbA1c (OR 2.9 per 1% increment, 2.6 - 3.2, p < 0.001), and speaking English (OR 2.1, 1.4-3.1, p < 0.001).ConclusionsDespite having had diabetes for an additional 10 years, patients in our longitudinal cohort had better glycemic and cholesterol control in 2006 than 1996. Greatest improvements occurred in patients with the highest levels in the baseline year.

Highlights

Our objectives were to examine temporal changes in HbA1c and lipid levels over a 10-year period and to identify predictors of metabolic control in a longitudinal patient cohort
Type 2 diabetes (T2D) is seen as an inexorably progressive disease, with beta cell failure and increasing peripheral insulin resistance leading to worsening glycemic control, microvascular complications such as retinopathy and peripheral neuropathy, and significant macrovascular morbidity [2,3,4]
Setting and Patients We used an electronic clinical data query to identify all adults with type 2 diabetes (T2D) receiving outpatient care at one of the 12 outpatient practices affiliated with Massachusetts General Hospital (MGH) in 1996

Summary

Introduction

Our objectives were to examine temporal changes in HbA1c and lipid levels over a 10-year period and to identify predictors of metabolic control in a longitudinal patient cohort. Several cross-sectional US national surveys have provided important population-level data on diabetes prevalence and metabolic control over time. Data from the National Health and Nutritional Examination Survey (NHANES), for example, have confirmed an increasing diabetes prevalence, increasing obesity among patients with diabetes, and an apparent trend towards improved metabolic control after years of worsening [7,8,9,10]. Interpretation of these trends is confounded by changes in US demographics and changes in screening criteria over the past decade. One study from the National Health Interview Survey, for example, found that despite significant increases in the diabetes population total each year, the mean age for patients with diabetes remained constant over an 8 year period [11]

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