The Legacy Effect in Type 2 Diabetes: Impact of Early Glycemic Control on Future Complications (The Diabetes & Aging Study) - PubMed (original) (raw)
. 2019 Mar;42(3):416-426.
doi: 10.2337/dc17-1144. Epub 2018 Aug 13.
Affiliations
- PMID: 30104301
- PMCID: PMC6385699
- DOI: 10.2337/dc17-1144
The Legacy Effect in Type 2 Diabetes: Impact of Early Glycemic Control on Future Complications (The Diabetes & Aging Study)
Neda Laiteerapong et al. Diabetes Care. 2019 Mar.
Abstract
Objective: To examine for a legacy effect of early glycemic control on diabetic complications and death.
Research design and methods: This cohort study of managed care patients with newly diagnosed type 2 diabetes and 10 years of survival (1997-2013, average follow-up 13.0 years, N = 34,737) examined associations between HbA1c <6.5% (<48 mmol/mol), 6.5% to <7.0% (48 to <53 mmol/mol), 7.0% to <8.0% (53 to <64 mmol/mol), 8.0% to <9.0% (64 to <75 mmol/mol), or ≥9.0% (≥75 mmol/mol) for various periods of early exposure (0-1, 0-2, 0-3, 0-4, 0-5, 0-6, and 0-7 years) and incident future microvascular (end-stage renal disease, advanced eye disease, amputation) and macrovascular (stroke, heart disease/failure, vascular disease) events and death, adjusting for demographics, risk factors, comorbidities, and later HbA1c.
Results: Compared with HbA1c <6.5% (<48 mmol/mol) for the 0-to-1-year early exposure period, HbA1c levels ≥6.5% (≥48 mmol/mol) were associated with increased microvascular and macrovascular events (e.g., HbA1c 6.5% to <7.0% [48 to <53 mmol/mol] microvascular: hazard ratio 1.204 [95% CI 1.063-1.365]), and HbA1c levels ≥7.0% (≥53 mmol/mol) were associated with increased mortality (e.g., HbA1c 7.0% to <8.0% [53 to <64 mmol/mol]: 1.290 [1.104-1.507]). Longer periods of exposure to HbA1c levels ≥8.0% (≥64 mmol/mol) were associated with increasing microvascular event and mortality risk.
Conclusions: Among patients with newly diagnosed diabetes and 10 years of survival, HbA1c levels ≥6.5% (≥48 mmol/mol) for the 1st year after diagnosis were associated with worse outcomes. Immediate, intensive treatment for newly diagnosed patients may be necessary to avoid irremediable long-term risk for diabetic complications and mortality.
© 2018 by the American Diabetes Association.
Figures
Figure 1
Definitions of early exposure periods and subsequent follow-up periods for the research design.
Figure 2
A: Microvascular events (vs. HbA1c <6.5% [<48 mmol/mol]). B: Macrovascular events (vs. HbA1c <6.5% [<48 mmol/mol]). C: Mortality (vs. HbA1c <6.5% [<48 mmol/mol]). HRs adjusted for year of diagnosis, age at diagnosis, sex, race/ethnicity, BMI, systolic and diastolic blood pressure, total cholesterol, HDL cholesterol, smoking status, HbA1c after each early exposure period, and comorbidity.
Comment in
- Response to Comment on Laiteerapong et al. The Legacy Effect in Type 2 Diabetes: Impact of Early Glycemic Control on Future Complications (The Diabetes & Aging Study). Diabetes Care 2019;42:416-426.
Laiteerapong N, Ham SA, Huang ES, Karter AJ. Laiteerapong N, et al. Diabetes Care. 2019 Mar;42(3):e46-e47. doi: 10.2337/dci18-0036. Epub 2019 Jan 24. Diabetes Care. 2019. PMID: 30679307 Free PMC article. No abstract available. - Therapeutic Inertia and the Legacy of Dysglycemia on the Microvascular and Macrovascular Complications of Diabetes.
Khunti K, Seidu S. Khunti K, et al. Diabetes Care. 2019 Mar;42(3):349-351. doi: 10.2337/dci18-0030. Diabetes Care. 2019. PMID: 30787057 No abstract available. - Diabetes: Hit hard and early, please!
Parhofer KG. Parhofer KG. MMW Fortschr Med. 2019 Apr;161(7):32. doi: 10.1007/s15006-019-0401-3. MMW Fortschr Med. 2019. PMID: 30989525 Review. German. No abstract available.
Similar articles
- Long-term visit-to-visit glycemic variability as predictor of micro- and macrovascular complications in patients with type 2 diabetes: The Rio de Janeiro Type 2 Diabetes Cohort Study.
Cardoso CRL, Leite NC, Moram CBM, Salles GF. Cardoso CRL, et al. Cardiovasc Diabetol. 2018 Feb 24;17(1):33. doi: 10.1186/s12933-018-0677-0. Cardiovasc Diabetol. 2018. PMID: 29477146 Free PMC article. - Effect of diabetes duration on the relationship between glycaemic control and risk of death in older adults with type 2 diabetes.
Ghouse J, Isaksen JL, Skov MW, Lind B, Svendsen JH, Kanters JK, Olesen MS, Holst AG, Nielsen JB. Ghouse J, et al. Diabetes Obes Metab. 2020 Feb;22(2):231-242. doi: 10.1111/dom.13891. Epub 2019 Nov 18. Diabetes Obes Metab. 2020. PMID: 31596048 - Visit-to-Visit HbA1c Variability Is Associated With Cardiovascular Disease and Microvascular Complications in Patients With Newly Diagnosed Type 2 Diabetes.
Li S, Nemeth I, Donnelly L, Hapca S, Zhou K, Pearson ER. Li S, et al. Diabetes Care. 2020 Feb;43(2):426-432. doi: 10.2337/dc19-0823. Epub 2019 Nov 14. Diabetes Care. 2020. PMID: 31727686 - Nutritional intervention and impact of polyphenol on glycohemoglobin (HbA1c) in non-diabetic and type 2 diabetic subjects: Systematic review and meta-analysis.
Palma-Duran SA, Vlassopoulos A, Lean M, Govan L, Combet E. Palma-Duran SA, et al. Crit Rev Food Sci Nutr. 2017 Mar 24;57(5):975-986. doi: 10.1080/10408398.2014.973932. Crit Rev Food Sci Nutr. 2017. PMID: 25746842 Review. - "Mild dysglycemia" in type 2 diabetes: to be neglected or not?
Monnier L, Colette C, Dejager S, Owens DR. Monnier L, et al. J Diabetes Complications. 2015 Apr;29(3):451-8. doi: 10.1016/j.jdiacomp.2014.12.004. Epub 2014 Dec 12. J Diabetes Complications. 2015. PMID: 25572605 Review.
Cited by
- The effects of dipeptidyl peptidase-4 inhibitors on cardiac structure and function using cardiac magnetic resonance: a meta-analysis of clinical studies.
Wang H, Guo S, Gu S, Li C, Wang F, Zhao J. Wang H, et al. Front Endocrinol (Lausanne). 2024 Sep 11;15:1428160. doi: 10.3389/fendo.2024.1428160. eCollection 2024. Front Endocrinol (Lausanne). 2024. PMID: 39324124 Free PMC article. - Efficacy and safety of finerenone in individuals with type 2 diabetes mellitus complicated by diabetic kidney disease: A retrospective observational study.
Kawaguchi Y, Hajika Y, Ashida N, Rinka M, Hamai C, Masumoto K, Sawa J, Hamazaki K, Kumeda Y. Kawaguchi Y, et al. Metabol Open. 2024 Sep 7;24:100318. doi: 10.1016/j.metop.2024.100318. eCollection 2024 Dec. Metabol Open. 2024. PMID: 39318608 Free PMC article. - The Association Between Triglyceride Glucose-Body Mass Index and Kidney Impairment in Patients with Type 2 Diabetes Mellitus.
Huang N, Lu B, Zhu ZZ, Zhu XY, Chen S, Shu ZY, Liu GF, Peng YF, Li L. Huang N, et al. Diabetes Metab Syndr Obes. 2024 Sep 16;17:3447-3453. doi: 10.2147/DMSO.S477836. eCollection 2024. Diabetes Metab Syndr Obes. 2024. PMID: 39309307 Free PMC article. - The association between uncontrolled hyperglycemia (Type-2 Diabetes) and cardiovascular sequelae in patients with and without insulin.
Alghadeer S, Mubarak AM, Alsuwayni B, Almurdhi F, Almalki H, Alotaibi M. Alghadeer S, et al. Saudi Pharm J. 2024 Oct;32(10):102168. doi: 10.1016/j.jsps.2024.102168. Epub 2024 Sep 4. Saudi Pharm J. 2024. PMID: 39295783 Free PMC article. - Point-of-care Testing HbA1c screening for type 2 diabetes in urban and rural areas of China: a cost-effectiveness analysis.
Shao Q, Xie X, Wang L, Gao L, Hu Y, Zhang Y. Shao Q, et al. Front Public Health. 2024 Jul 30;12:1438945. doi: 10.3389/fpubh.2024.1438945. eCollection 2024. Front Public Health. 2024. PMID: 39139662 Free PMC article.
References
- Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008;359:1577–1589 - PubMed
- de Boer IH, Rue TC, Cleary PA, et al. .; Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study Research Group . Long-term renal outcomes of patients with type 1 diabetes mellitus and microalbuminuria: an analysis of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications cohort. Arch Intern Med 2011;171:412–420 - PMC - PubMed
- Nathan DM, Cleary PA, Backlund JY, et al. .; Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group . Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 2005;353:2643–2653 - PMC - PubMed
- Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Study Research Group Intensive diabetes treatment and cardiovascular outcomes in type 1 diabetes: the DCCT/EDIC study 30-year follow-up. Diabetes Care 2016;39:686–693 - PubMed
- Chalmers J, Cooper ME. UKPDS and the legacy effect. N Engl J Med 2008;359:1618–1620 - PubMed
Publication types
MeSH terms
Substances
Grants and funding
- K24 DK105340/DK/NIDDK NIH HHS/United States
- P30 DK092924/DK/NIDDK NIH HHS/United States
- R56 AG051683/AG/NIA NIH HHS/United States
- P30 DK092949/DK/NIDDK NIH HHS/United States
- R01 DK081796/DK/NIDDK NIH HHS/United States
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Miscellaneous