Diabetes Metab J.  2021 May;45(3):368-378. 10.4093/dmj.2020.0046.

Time to Reach Target Glycosylated Hemoglobin Is Associated with Long-Term Durable Glycemic Control and Risk of Diabetic Complications in Patients with Newly Diagnosed Type 2 Diabetes Mellitus: A 6-Year Observational Study

• Kim KJ
• Choi J
• Bae JH
• Kim KJ
• Yoo HJ
• Seo JA
• Kim NH
• Choi KM
• Baik SH
• Kim SG
• Kim NH

• KMID: 2516339
• DOI: http://doi.org/10.4093/dmj.2020.0046

Abstract

Background
To evaluate the association of time to reach the target glycosylated hemoglobin (HbA1c) level with long-term durable glycemic control and risk of diabetic complications in patients with newly diagnosed type 2 diabetes mellitus (T2DM).
Methods
In a longitudinal observational cohort, 194 patients with T2DM newly diagnosed between January 2011 and March 2013 were followed up over 6 years. Patients were classified according to the time needed to reach the target HbA1c (<7.0%): <3, 3 to 6 (early achievement group), and ≥6 months (late achievement group). Risks of microvascular complications including diabetic retinopathy, nephropathy, and neuropathy as well as macrovascular events including ischemic heart disease, ischemic stroke, and peripheral arterial disease were assessed by multivariable Cox proportional hazards analysis.
Results
During a median follow-up of 6.53 years, 66 microvascular and 14 macrovascular events occurred. Maintenance of durable glycemic control over 6 years was more likely in the early achievement groups than in the late achievement group (34.5%, 30.0%, and 16.1% in <3, 3 to 6, and ≥6 months, respectively, P=0.039). Early target HbA1c achievement was associated with lower risk of composite diabetic complications (adjusted hazard ratio [HR, 0.47; 95% confidence interval [CI], 0.26 to 0.86 in <3 months group) (adjusted HR, 0.50; 95% CI, 0.23 to 1.10 in 3 to 6 months group, in reference to ≥6 months group). Similar trends were maintained for risks of microvascular and macrovascular complications, although statistical significance was not reached for macrovascular complications.
Conclusion
Early target HbA1c achievement was associated with long-term durable glycemic control and reduced risk of diabetic complications in newly diagnosed T2DM.

Keyword

Cohort studies; Diabetes complications; Diabetes mellitus, type 2; Glycated hemoglobin A

Figure

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  Fig. 1. The proportion of long-term glycemic control according to the time to reach target glycosylated hemoglobin (HbA1c; <7.0%) (differences between groups, P=0.039).

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  Fig. 2. Kaplan-Meier curves for cumulative survival incidence of diabetic complications according to time to reach target glycosylated hemoglobin. (A) Composite complications (log rank test, early achievement groups vs. late achievement group; P=0.060). (B) Microvascular outcomes (log rank test, early achievement groups vs. late achievement group; P=0.034). DFS, disease free survival.

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