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

Louise A. Donnelly, Kaixin Zhou, Alex S.F. Doney, Chris Jennison, Paul W. Franks, Ewan R. Pearson

Research output: Contribution to journalArticle

14 Citations (Scopus)
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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 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.

Original languageEnglish
Pages (from-to)607-615
Number of pages9
JournalDiabetologia
Volume61
Issue number3
Early online date19 Dec 2017
DOIs
Publication statusPublished - 1 Mar 2018

Keywords

  • Coefficient of failure
  • Elderly
  • Electronic medical records
  • Glycaemic deterioration
  • Observational
  • Type 2 diabetes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

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    Donnelly, L. A., Zhou, K., Doney, A. S. F., Jennison, C., Franks, P. W., & Pearson, E. R. (2018). Rates of glycaemic deterioration in a real-world population with type 2 diabetes. Diabetologia, 61(3), 607-615. https://doi.org/10.1007/s00125-017-4519-5