J Korean Med Sci.  2022 Oct;37(38):e281. 10.3346/jkms.2022.37.e281.

Long-Term Changes in HbA1c According to Blood Glucose Control Status During the First 3 Months After Visiting a Tertiary University Hospital

• Kim H
• Jung DY
• Lee SH
• Cho JH
• Yim HW
• Kim HS

• KMID: 2533562
• DOI: http://doi.org/10.3346/jkms.2022.37.e281

Abstract

Background
We evaluated patients visiting a tertiary university hospital due to a diagnosis of diabetes with a goal of achieving blood glucose control and evaluated blood glucose persistence over 7 years according to the change in blood glucose evident at 3 months after the first visit.
Methods
Patients treated from 2009 to 2013 were categorized into four groups according to the change in HbA1c levels during the first 3 months of follow-up (Best_group, ≥ 1.6% decrease; Better_group, 0.5–1.5% decrease; Neutral_group, maintained at −0.4% to +0.4%; Worse_group, ≥ 0.5% increase). Each patient’s blood glucose control status was then monitored for 7 years. The incidence of stroke and acute coronary syndrome during this period was confirmed.
Results
Overall, 9,776 patients were included. HbA1c values were lower in the Best_group than in the other groups at all time points (all P < 0.001). The rate of reaching targets of < 6.5% or < 7.0% HbA1c decreased over time; the rate at which the estimated glomerular filtration rate decreased to < 30 or < 60 mL/min/1.73m ² increased over time (all trends, P < 0.01).
Conclusion
Blood glucose control status in the first 3 months after initiating hospital care enabled estimation of the patient’s glycemic control status for the next 7 years. In cases with poor initial blood glucose control, a new or more active method of blood glucose control should be sought.

Keyword

Blood Glucose; Diabetes Mellitus; Glycemic Control

Figure

• 

  Fig. 1 Changes during 84 months of follow-up in patients with diabetes undergoing treatment at a tertiary university hospital. (A) HbA1c changes according to baseline HbA1c values. (B) Target achievement rates in regard to HbA1c levels. (C) Respective rates of achieving estimated glomerular filtration rates of < 30 mL/min/1.73m2 and < 60 mL/min/1.73m2.HbA1c = hemoglobin A1c.

• 

  Fig. 2 Changes in HbA1c levels during 84 months of follow-up according to glycemic control status within the first 3 months after visiting a tertiary care hospital: (A) Baseline HbA1c < 7.0%, (B) 7.0% ≤ baseline HbA1c < 8.0%, (C) 8.0% ≤ baseline HbA1c < 9.0%, (D) 9.0% ≤ baseline HbA1c < 10.0%, and (E) ≥ 10.0% baseline HbA1c.HbA1c = hemoglobin A1c.

• 

  Fig. 3 Cumulative occurrence graph over the course of 7 years for (A) acute coronary syndrome and (B) stroke; P values were calculated using analysis of variance tests.

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