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Rates of glycaemic deterioration in a real-world population with type 2 diabetes

Donnelly, Louise A.; Zhou, Kaixin; Doney, Alex S.F.; Jennison, Chris; Franks, Paul W. LU and Pearson, Ewan R. (2018) In Diabetologia 61(3). p.607-615
Abstract

Aims/hypothesis: There is considerable variability in how diabetes progresses after diagnosis. Progression modelling has largely focused on ‘time to failure’ methods, yet determining a ‘coefficient of failure’ has many advantages. We derived a rate of glycaemic deterioration in type 2 diabetes, using a large real-world cohort, and aimed to investigate the clinical, biochemical, pharmacological and immunological variables associated with fast and slow rates of glycaemic deterioration. Methods: An observational cohort study was performed using the electronic medical records from participants in the Genetics of Diabetes Audit and Research in Tayside Study (GoDARTS). A model was derived based on an individual’s observed HbA1c... (More)

Aims/hypothesis: There is considerable variability in how diabetes progresses after diagnosis. Progression modelling has largely focused on ‘time to failure’ methods, yet determining a ‘coefficient of failure’ has many advantages. We derived a rate of glycaemic deterioration in type 2 diabetes, using a large real-world cohort, and aimed to investigate the clinical, biochemical, pharmacological and immunological variables associated with fast and slow rates of glycaemic deterioration. Methods: An observational cohort study was performed using the electronic medical records from participants in the Genetics of Diabetes Audit and Research in Tayside Study (GoDARTS). A model was derived based on an individual’s observed HbA1c measures from the first eligible HbA1c after the diagnosis of diabetes through to the study end (defined as insulin initiation, death, leaving the area or end of follow-up). Each HbA1c measure was time-dependently adjusted for the effects of non-insulin glucose-lowering drugs, changes in BMI and corticosteroid use. GAD antibody (GADA) positivity was defined as GAD titres above the 97.5th centile of the population distribution. Results: The mean (95% CI) glycaemic deterioration for type 2 diabetes and GADA-positive individuals was 1.4 (1.3, 1.4) and 2.8 (2.4, 3.3) mmol/mol HbA1c per year, respectively. A younger age of diagnosis, lower HDL-cholesterol concentration, higher BMI and earlier calendar year of diabetes diagnosis were independently associated with higher rates of glycaemic deterioration in individuals with type 2 diabetes. The rate of deterioration in those diagnosed at over 70 years of age was very low, with 66% having a rate of deterioration of less than 1.1 mmol/mol HbA1c per year, and only 1.5% progressing more rapidly than 4.4 mmol/mol HbA1c per year. Conclusions/interpretation: We have developed a novel approach for modelling the progression of diabetes in observational data across multiple drug combinations. This approach highlights how glycaemic deterioration in those diagnosed at over 70 years of age is minimal, supporting a stratified approach to diabetes management.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Coefficient of failure, Elderly, Electronic medical records, Glycaemic deterioration, Observational, Type 2 diabetes
in
Diabetologia
volume
61
issue
3
pages
607 - 615
publisher
Springer Verlag
external identifiers
  • scopus:85038355682
ISSN
0012-186X
DOI
10.1007/s00125-017-4519-5
language
English
LU publication?
yes
id
126d682f-8f01-44cb-9d89-c5e7c6f60153
date added to LUP
2018-01-03 12:03:44
date last changed
2018-08-19 04:40:17
@article{126d682f-8f01-44cb-9d89-c5e7c6f60153,
  abstract     = {<p>Aims/hypothesis: There is considerable variability in how diabetes progresses after diagnosis. Progression modelling has largely focused on ‘time to failure’ methods, yet determining a ‘coefficient of failure’ has many advantages. We derived a rate of glycaemic deterioration in type 2 diabetes, using a large real-world cohort, and aimed to investigate the clinical, biochemical, pharmacological and immunological variables associated with fast and slow rates of glycaemic deterioration. Methods: An observational cohort study was performed using the electronic medical records from participants in the Genetics of Diabetes Audit and Research in Tayside Study (GoDARTS). A model was derived based on an individual’s observed HbA<sub>1c</sub> measures from the first eligible HbA<sub>1c</sub> after the diagnosis of diabetes through to the study end (defined as insulin initiation, death, leaving the area or end of follow-up). Each HbA<sub>1c</sub> measure was time-dependently adjusted for the effects of non-insulin glucose-lowering drugs, changes in BMI and corticosteroid use. GAD antibody (GADA) positivity was defined as GAD titres above the 97.5th centile of the population distribution. Results: The mean (95% CI) glycaemic deterioration for type 2 diabetes and GADA-positive individuals was 1.4 (1.3, 1.4) and 2.8 (2.4, 3.3) mmol/mol HbA<sub>1c</sub> per year, respectively. A younger age of diagnosis, lower HDL-cholesterol concentration, higher BMI and earlier calendar year of diabetes diagnosis were independently associated with higher rates of glycaemic deterioration in individuals with type 2 diabetes. The rate of deterioration in those diagnosed at over 70 years of age was very low, with 66% having a rate of deterioration of less than 1.1 mmol/mol HbA<sub>1c</sub> per year, and only 1.5% progressing more rapidly than 4.4 mmol/mol HbA<sub>1c</sub> per year. Conclusions/interpretation: We have developed a novel approach for modelling the progression of diabetes in observational data across multiple drug combinations. This approach highlights how glycaemic deterioration in those diagnosed at over 70 years of age is minimal, supporting a stratified approach to diabetes management.</p>},
  author       = {Donnelly, Louise A. and Zhou, Kaixin and Doney, Alex S.F. and Jennison, Chris and Franks, Paul W. and Pearson, Ewan R.},
  issn         = {0012-186X},
  keyword      = {Coefficient of failure,Elderly,Electronic medical records,Glycaemic deterioration,Observational,Type 2 diabetes},
  language     = {eng},
  number       = {3},
  pages        = {607--615},
  publisher    = {Springer Verlag},
  series       = {Diabetologia},
  title        = {Rates of glycaemic deterioration in a real-world population with type 2 diabetes},
  url          = {http://dx.doi.org/10.1007/s00125-017-4519-5},
  volume       = {61},
  year         = {2018},
}