Longitudinal HbA1c patterns before the first treatment of diabetes in routine clinical practice: A latent class trajectory analysis.

Autor: Nicolaisen SK; Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark. Electronic address: sknc@clin.au.dk., le Cessie S; Department of Clinical Epidemiology & Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands., Thomsen RW; Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark., Witte DR; Steno Diabetes Center Aarhus, Aarhus, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark., Dekkers OM; Department of Clinical Epidemiology & Department of Endocrinology and Metabolism, Leiden University Medical Center, Leiden, the Netherlands., Sørensen HT; Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark., Pedersen L; Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark.
Jazyk: angličtina
Zdroj: Diabetes research and clinical practice [Diabetes Res Clin Pract] 2024 Jun; Vol. 212, pp. 111722. Date of Electronic Publication: 2024 May 28.
DOI: 10.1016/j.diabres.2024.111722
Abstrakt: Aims: To examine the longitudinal heterogeneity of HbA1c preceding the initiation of diabetes treatment in clinical practice.
Methods: In this population-based study, we used HbA1c from routine laboratory and healthcare databases. Latent class trajectory analysis was used to classify individuals according to their longitudinal HbA1c patterns before first glucose-lowering drug prescription irrespective of type of diabetes.
Results: Among 21,556 individuals initiating diabetes treatment during 2017-2018, 20,733 (96 %) had HbA1c measured (median 4 measurements [IQR 2-7]) in the 5 years preceding treatment initiation. Four classes with distinct HbA1c trajectories were identified, with varying steepness of increase in HbA1c. The largest class (74 % of the individuals) had mean HbA1c above the 48 mmol/mol threshold 9 months before treatment initiation. Mean HbA1c was 52 mmol/mol (95 % CI 52-52) at treatment initiation. In the remaining three classes, mean HbA1c exceeded 48 mmol/mol almost 1.5 years before treatment initiation and reached 79 mmol/mol (95 % CI 78-80), 105 mmol/mol (95 % CI 104-106), and 137 mmol/mol (95 % CI 135-140) before treatment initiation.
Conclusion: We identified four distinct longitudinal HbA1c patterns before initiation of diabetes treatment in clinical practice. All had mean HbA1c levels exceeding the diagnostic threshold many months before treatment initiation, indicating therapeutic inertia.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The Department of Clinical Epidemiology is involved in studies with funding from various companies as research grants to, and administered by, Aarhus University. None of these studies are related to the current study. SKN received a travel grant from The Danish Diabetes Association.
(Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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