Precise monthly achievement rates for reaching guideline targets for HbA 1c , blood pressure (BP), and lipid levels remain unknown. We evaluated achievement rates on a monthly basis in persons with type 2 diabetes mellitus (T2DM) and explored related factors. RESEARCH DESIGN AND METHODS This retrospective study initially analyzed data on 104,601 persons with T2DM throughout Japan. Patients whose HbA 1c , BP, and LDL cholesterol were measured ‡12 times during a 24-month period were included. We evaluated monthly achievement rates. Achieved targets were defined as HbA 1c <7%, BP <130/ 80 mmHg, and LDL cholesterol <100 mg/dL. Achievement of all targets was expressed as the "all ABC achievement." RESULTS A total of 4,678 patients were analyzed. The achievement rates of all ABC, HbA 1c , BP, and LDL cholesterol were lowest in winter, with those for systolic BP (SBP) being particularly low (all ABC, summer 15.6%, winter 9.6%; HbA 1c , 53.1%, 48.9%; SBP, 56.6%, 40.9%; LDL cholesterol, 50.8%, 47.2%). In winter, age ‡65 years (odds ratio 0.47 [95% CI 0.34-0.63]) was independently related to decreased achievement rates for SBP, BMI ‡25 kg/m 2 (BMI 25-30 kg/m 2 , 0.45 [0.29-0.70]; BMI ‡30 kg/m 2 , 0.35 [0.22-0.57]), and diabetes duration ‡10 years (0.53 [0.37-0.76]) were independently related to lower achievement rates for HbA 1c. Insulin use and sulfonylurea use were independently associated with the decreased all ABC achievement rates in both summer and winter. CONCLUSIONS The all ABC achievement rate for guideline targets changed on a monthly basis. Seasonal variations in the all ABC achievement rate should be considered when managing T2DM in ordinary clinical practices.

BackgroundThe relationship between long-term glycemic variability (GV) represented by visit-to-visit HbA1c variability and baroreflex sensitivity (BRS) in type 2 diabetes mellitus (T2DM) has not been clarified by previous literature. The present study is the first to examine the relationships between visit-to-visit HbA1c variability and BRS.MethodsThis retrospective study initially analyzed data on 94 patients with T2DM. Visit-to-visit HbA1c variability was evaluated using the intrapersonal coefficient of variation (CV), standard deviation (SD), and adjusted SD of 8 or more serial measurements of HbA1c during a 2-year period. The BRS was analyzed using the sequence method. Short-term GV was assessed by measuring the glucose CV during 24-h continuous glucose monitoring (CGM). The primary objective was to determine if there was a relationship between visit-to-visit HbA1c variability (HbA1c CV) and BRS. Secondary objectives were to examine the relationship between other variables and BRS and the respective and combined effects of long-term GV (HbA1c CV) and short-term GV (CGM CV) on BRS.ResultsA total of 57 patients (mean age 67.2 ± 7.7 years, mean HbA1c 7.3 ± 1.0%) who met this study’s inclusion criteria were finally analyzed. In the univariate analysis, HbA1c CV (r = − 0.354, p = 0.007), HbA1c SD (r = − 0.384, p = 0.003), and adjusted HbA1c SD (r = − 0.391, p = 0.003) were significantly related to low levels of BRS. Multiple regression analysis showed that HbA1c CV, HbA1c SD, and adjusted HbA1c SD were inversely related to BRS. Furthermore, although the increase in either long-term GV (HbA1c CV) or short-term GV (CGM CV) as determined by 24-h CGM was inversely correlated with BRS, additional reductions in BRS were not shown in participants with both HbA1c CV and CGM CV values above the median.ConclusionsVisit-to-visit HbA1c variability was inversely related to BRS independently of the mean HbA1c in patients with T2DM. Therefore, visit-to-visit HbA1c variability might be a marker of reduced BRS in T2DM.

Aim: The present study is the first to investigate association between Diabetic Kidney Disease (DKD) and Visit-to-Visit Variability (VVV) of HbA1c, blood pressure (BP), and body mass index (BMI) in patients with T2DM whose HbA1c, BP, and BMI were measured ≥12 times during a 2-year period. Material and Methods: This retrospective clinical trial initially analyzed data on 104,601 persons with T2DM in 38 clinical centers. We included 20- to 75-year-old patients whose HbA1c, systolic BP (SBP), and BMI were measured ≥12 times during a 2-year period. VVV was calculated using the coefficient of variation. VVVs of HbA1c, SBP, and BMI respectively, were divided into two groups by median value (high or low VVV). Risk of DKD were analyzed by multivariate logistic regression analysis. DKD was defined as urine albumin-to-creatinine ratio ≥30mg/g Cr or eGFR &lt;60 mL/min/1.73 m2. Results: A total of 12,575 patients who met the inclusion criteria were finally analyzed. Adjusted odds ratios (ORs) for high risk of DKD were 1.33 (95% CI 1.22-1.46, p &lt; 0.001) for high VVV of HbA1c, 1.18 (1.08-1.28, p &lt; 0.001) for high VVV of SBP, and 1.19 (1.10-1.30, p &lt; 0.001) for high VVV of BMI. Male sex 1.29 (1.12-1.34, p &lt; 0.001), advanced age, longer diabetes duration, presence of hypertension 1.19 (1.03-1.38, p = 0.02), anti-hypertensive agent use 1.40 (1.22-1.61, p &lt; 0.001), presence of dyslipidemia 1.24 (1.11-1.39, p &lt; 0.001), higher 2-year mean HbA1c, higher 2-year mean SBP, and higher 2-year mean BMI were also related to high risk of DKD. Additionally, the analysis of antidiabetic drug use revealed that particularly use of insulin 1.50 (1.34-1.68, p &lt; 0.001) and sulfonylurea use 1.24 (1.13-1.37, p &lt; 0.001) were associated with high risk of DKD. Conclusion: High VVV of HbA1c, SBP, and BMI were associated with DKD independently of mean HbA1c, SBP, and BMI values. Disclosure D. Matsutani: None. S. Minato: None. Y. Tsujimoto: None. H. Maegawa: Speaker’s Bureau; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Sanofi K.K., Takeda Pharmaceutical Company Limited. M. Sakamoto: None.

Aim: Precise monthly achievement rates for reaching guideline goals for HbA1c, blood pressure (BP), and cholesterol levels remain unknown. We evaluated achievement rates on a monthly basis in patients with type 2 diabetes mellitus (T2DM) and explored related factors. Material and Methods: This retrospective study initially analyzed data on 104,601 patients with T2DM throughout Japan (38 medical clinics). Patients whose HbA1c, BP, and low-density lipoprotein (LDL)-cholesterol were measured ≥12 times during a 2-year period were included. We evaluated monthly achievement rates. Achieved goals were defined as HbA1c &lt;7%, BP &lt;130/80 mmHg, and LDL-cholesterol &lt;100 mg/dL. Achievement of all goals was expressed as the "all ABC achievement." Results: A total of 4,678 patients were analyzed. The achievement rates of all ABC, HbA1c, BP, and LDL-cholesterol exhibited seasonal variations with the lowest rates in winter, with those for systolic BP (SBP) being particularly low (all ABC, summer 15.6%, winter 9.6%; HbA1c, 53.1%, 48.9%; SBP, 56.6%, 40.9%; LDL-cholesterol, 50.8%, 47.2%). In the multiple logistic regression analysis, in winter, BMI ≥25 kg/m2 (BMI 25-30 kg/m2, odds ratio 0.45 [0.29-0.70], p &lt; 0.001; BMI ≥30 kg/m2, 0.35 [0.22-0.57], p &lt; 0.001) and diabetes duration ≥10 years (0.53 [0.37-0.76], p &lt; 0.001) were independently related to lower achievement rates for HbA1c, and age ≥65 years (0.47 [95% CI 0.34-0.63], p &lt; 0.001) was independently related to decreased achievement rates for SBP. Insulin and sulfonylurea use were independently associated with the decreased all ABC achievement rates in both summer and winter. Conclusion: This study showed that in patients with T2DM, the achievement rates for blood glucose, BP, and lipid goal levels varied seasonally. Seasonal variations in the all ABC achievement rate should be considered when managing T2DM in ordinary clinical practices. Disclosure D. Matsutani: None. M. Sakamoto: None. S. Minato: None. Y. Tsujimoto: None. Y. Kayama: None. K. Utsunomiya: None. M. Nishikawa: None.

Aim: Visit-to-visit variability (VVV) of HbA1c was reported to be the risk of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM). However, factors related to VVV of HbA1c remain unclear. This study is first examined relationship between VVV of HbA1c and various parameters including VVV of blood pressure (BP), low-density lipoprotein-cholesterol (LDL-C), and body mass index (BMI). Material and Methods: Analyzed were 4,678 patients with T2DM throughout Japan (38 hospitals). The inclusion criteria were patients whose HbA1c, BP, LDL-C, and BMI were measured 12 or more times during the 24-month period. VVV of HbA1c, BP, LDL-C, and BMI were evaluated using the coefficient of variation (CV). This study is sub-analysis of ABC trial (UMIN000034231). Results: Mean age of participants was 61.3 ± 9.4 years (mean ± SD) and HbA1c was 57.2 ± 13.5 mmol/mol (7.4 ± 1.2%). Table shows univariate correlate and multiple regression analysis of HbA1c CV. HbA1c CV was correlated with HbA1c baseline, SBP CV, LDL-C CV, and BMI CV. In the multiple regression analysis, HbA1c baseline, LDL-C, and BMI CV were the strongest predictors of HbA1c CV. Conclusion: VVV of HbA1c was strongly correlated with VVV of LDL-C and BMI, and HbA1c baseline in patients with T2DM. A large-scale clinical trial needs to be conducted to clarify factors affecting VVV of HbA1c. Disclosure S. Minato: None. D. Matsutani: None. Y. Tsujimoto: None. Y. Kayama: None. M. Sakamoto: None. M. Nishikawa: None. K. Utsunomiya: None.