期刊
JOURNAL OF DIABETES AND ITS COMPLICATIONS
卷 31, 期 1, 页码 94-100出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jdiacomp.2016.07.023
关键词
Epidemiology; Legacy effect; Microvascular disease; Mortality; Glycemic control
资金
- NIDDK [K23 DK092783, K24 DK105340, R01DK081796]
Aims: To classify trajectories of long term HbAlc values in patients after diagnosis of type 2 diabetes and examine each trajectory's associations with subsequent microvascular and macrovascular events and mortality. Methods: A longitudinal follow-up of 28,016 patients newly diagnosed with type 2 diabetes was conducted. Latent growth mixture modeling was used to identify ten-year HbA1c trajectories. Cox proportional hazards models were used to assess how HbAlc trajectories were associated with events (microvascular and macrovascular) and mortality. Results: We identified 5 HbAlc trajectories: low stable (82.5%), moderate increasing late (5.1%), high decreasing early (4.9%), moderate peaking late (4.1%) and moderate peaking early (3.3%). After adjusting for average HbAlc, compared to the low stable trajectory, all non-stable trajectories were associated with higher incidences of microvascular events (hazard ratio (HR) range, 1.28 (95% CI, 1.08-1.53) (high decreasing early) to 1.45 (95% CI, 1.20-1.75) (moderate peaking early)). The high decreasing early trajectory was associated with an increased mortality risk (HR, 1.27 (95% Cl, 1.03-1.58)). Trajectories were not associated with macrovascular events. Conclusions: Non-stable HbA1c trajectories were associated with greater risk of microvascular events and mortality. These findings suggest a potential benefit of early diabetes detection, prioritizing good glycemic control, and maintaining control over time. (C) 2017 Elsevier Inc. All rights reserved.
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