Diabetes Complications at Presentation and One Year by Glycated Haemoglobin at Diagnosis in a Multiethnic and Diverse Socioeconomic Population: Results from the South London Diabetes Study

Abstract

Background. WHO's recommendation of HbA1c ≥ 48 mmol/mol (6.5%) as diagnostic for type 2 diabetes mellitus (T2DM) was adopted by three UK London boroughs in May 2012. The South London Diabetes (SOUL-D) study has recruited people with newly diagnosed T2DM since 2008. We compared participants diagnosed before May 2012 with HbA1c < 48 mmol/mol to those with diagnostic HbA1c ≥ 48 mmol/mol. Methods. A prospective cohort study of newly diagnosed T2DM participants from 96 primary care practices, comparing demographic and biomedical variables between those with diagnostic HbA1c < 48 mmol/mol or HbA1c ≥ 48 mmol/mol at recruitment and after one year. Results. Of 1488 participants, 22.8% had diagnostic HbA1c < 48 mmol/mol. They were older and more likely to be white (p < 0.05). At recruitment and one year, there were no between-group differences in the prevalence of diabetic complications, except that those diagnosed with HbA1c < 48 mmol/mol had more sensory neuropathy at recruitment (p = 0.039) and, at one year, had new myocardial infarction (p = 0.012) but less microalbuminuria (p = 0.012). Conclusions. Use of HbA1c ≥ 48 mmol/mol as the sole T2DM diagnostic criterion may miss almost a quarter of those previously diagnosed in South London yet HbA1c < 48 mmol/mol may not exclude clinically important diabetes.

Population, general practitioner and practice characteristics are associated with screening procedures for microvascular complications in Type 2 diabetes care in Norway

“…Because > 50% of the people with diabetes had adequate glucose control in our study, GPs may consider microvascular screening to be unnecessary and downgrade screening procedures in a busy working day. However, microvascular complications are present also in newly diagnosed and well‐regulated people, with and without medication . The prevalence of albuminuria, neuropathy and retinopathy were ~ 10% each in newly diagnosed persons in the UK and the percentage of microvascular complications were similar regardless of mean HbA 1c levels at baseline; i.e.…”

“…However, microvascular complications are present also in newly diagnosed and wellregulated people, with and without medication [21][22][23]. The prevalence of albuminuria, neuropathy and retinopathy werẽ 10% each in newly diagnosed persons in the UK [21] and the percentage of microvascular complications were similar regardless of mean HbA 1c levels at baseline; i.e. in the group with mean HbA 1c as low as 44 mmol/mol (6.2%) vs. the group with mean HbA 1c 58 mmol/mol (7.5%).…”

Newly diagnosed type 2 diabetes in an ethnic minority population: clinical presentation and comparison to other populations

“…The main outcome was evaluation of diabetes-related complications at the time of clinical diagnosis of diabetes. Secondary outcomes included identification of the demographic and clinical factors associated with the development of these complications as well as comparing our study group to those newly diagnosed with type 2 diabetes in two other clinical and socioeconomic settings: a diverse population in south London 15 and insured patients in Portland, Oregon. 16 …”

“…In this study, we aimed to assess the clinical presentation and prevalence of diabetes complications in underserved minority patients in a large urban area at the time of initial diagnosis of type 2 diabetes and compare results to other studies that assessed the same outcomes: a diverse population in South London, UK 15 and an insured population in Portland, Oregon, USA. 16 …”

A prospective randomized study: role of enalapril on oxidative stress in newly diagnosed type 2 diabetes mellitus and its correlation with glycaemic status

“…Glycated haemoglobin is recommended for checking blood sugar control in people who might be pre-diabetic and monitoring blood sugar control in patients with more elevated levels. 6,7 The primary goal of type 2 DM treatment is to achieve and maintain good glycemic control, and to reduce the mortality and risk of microvascular and macrovascular complications .The current management of type 2 DM is a combination of lifestyle intervention and Metformin as initial therapy for type 2 DM, followed by other Oral Hypoglycemic Agents and Insulin. 8 Besides Biguanides (Metformin), other antidiabetic agents include Sulfonylureas, Glitinides, Thiazolidinediones or Glitazones, α-glucosidase inhibitors (Acarbose), GLP1analogues, Dipeptidyl peptidase 4 inhibitors, Amylin agonists (Pramlintide) and Sodium glucose co transport-2 inhibitors (Dapaglifozin).…”