The Legacy Effect in Type 2 Diabetes: Impact of Early Glycemic Control on Future Complications (The Diabetes &amp; Aging Study)

Laiteerapong, Neda; Ham, Sandra A.; Gao, Yue; Moffet, Howard H.; Liu, Jennifer Y.; Huang, Elbert S.; Karter, Andrew J.

doi:10.2337/dc17-1144

Cited by 442 publications

(382 citation statements)

References 26 publications

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“…The interaction between diabetes duration and glycaemic control on the risk of death that we report could potentially also explain the inconsistencies between previous observational studies on older patients with T2D, which have reported both linear 32,33 and nonlinear relationships 30,34,35 between levels of glycaemia and mortality risk. Although the present study does not allow for causal inference due to its observational design, our results suggest that aiming for normoglycaemic levels in those with short duration of diabetes may be beneficial, whereas for individuals with long diabetes duration, setting universal goals may be less straightforward.…”

Section: Discussioncontrasting

confidence: 68%

“…Previous studies on middle-aged patients with T2D have shown conflicting results concerning the relationship between glycaemic control, diabetes duration and mortality risk. For instance, in a recent study by Laiteerapong et al 34 the authors found that newly diagnosed middle-aged patients with tight glycaemic control (6.5% [<48 mmol/mol ]) had the lowest mortality risk, with increasing effect sizes with longer exposure to poor glycaemic control. 34 As opposed to our results on elderly patients, they found no increased mortality risk in the normoglycaemic range with increasing duration of diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…For instance, in a recent study by Laiteerapong et al 34 the authors found that newly diagnosed middle-aged patients with tight glycaemic control (6.5% [<48 mmol/mol ]) had the lowest mortality risk, with increasing effect sizes with longer exposure to poor glycaemic control. 34 As opposed to our results on elderly patients, they found no increased mortality risk in the normoglycaemic range with increasing duration of diabetes. In another, smaller study (531 individuals) of middle-aged patients with T2D, it was found that long diabetes duration (≥5 years) and good glycaemic control (<6.5% [48 mmol/mol]) was associated with increased risk of death.…”

Section: Discussionmentioning

confidence: 99%

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Effect of diabetes duration on the relationship between glycaemic control and risk of death in older adults with type 2 diabetes

Ghouse

Isaksen

Skov

et al. 2019

Diabetes Obesity Metabolism

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Aim To investigate the effect of diabetes duration on glycaemic control, measured using mean glycated haemoglobin (HbA1c) level, and mortality risk within different age, sex and clinically relevant, comorbidity‐defined subgroups in an elderly population with type 2 diabetes (T2D). Methods We studied older (≥65 years) primary care patients with T2D, who had three successive annual measurements of HbA1c taken between 2005 and 2013. The primary exposure was the mean of all three HbA1c measurements. Follow‐up began on the date of the third measurement. Individual mean HbA1c levels were categorized into clinically relevant groups (<6.5% [<48 mmol/mol]; 6.5%‐6.9% [48‐52 mmol/mol]; 7%‐7.9% [53‐63 mmol/mol]; 8%‐8.9% [64‐74 mmol/mol]; and ≥9% [≥75 mmol/mol]). We used multiple Cox regression to study the effect of glycaemic control on the hazard of all‐cause mortality, adjusted for age, sex, use of concomitant medication, and age‐ and disease‐related comorbidities. Results A total of 9734 individuals were included. During a median (interquartile range) follow‐up of 7.3 (4.6‐8.7) years, 3320 individuals died. We found that the effect of mean HbA1c on all‐cause mortality depended on the duration of diabetes (P for interaction <.001). For individuals with short diabetes duration (<5 years), the risk of death increased with poorer glycaemic control (increasing HbA1c), whereas for individuals with longstanding diabetes (≥5 years), we found a J‐shaped association, where a mean HbA1c level between 6.5% and 7.9% [48 and 63 mmol/mol] was associated with the lowest risk of death. For individuals with longstanding diabetes, both low (<6.5% [<48 mmol/mol]; hazard ratio [HR] 1.21, 95% confidence interval [CI] 1.07‐1.37, P = .002) and high mean HbA1c levels (≥9.0% [≥75 mmol/mol]; HR 1.60, 95% CI 1.28‐1.99, P < .001) were associated with an increased risk of death. We also calculated 5‐year absolute risks of all‐cause mortality, separately for short and long diabetes duration, and found similar risk patterns across different age groups, sex and comorbidity strata. Conclusions In elderly individuals with T2D, the effect of glycaemic control (measured by HbA1c) on all‐cause mortality depended on the duration of diabetes. Of particular clinical importance, we found that strict glycaemic control was associated with an increased risk of death among individuals with long (≥ 5 years) diabetes duration. Conversely, for individuals with short diabetes duration, strict glycaemic control was associated with the lowest risk of death. These results indicate that tight glycemic control may be beneficial in people with short duration of diabetes, whereas a less stringent target may be warranted with longer diabetes exposure.

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Section: Discussioncontrasting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effect of diabetes duration on the relationship between glycaemic control and risk of death in older adults with type 2 diabetes

Ghouse

Isaksen

Skov

et al. 2019

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

show abstract

“…A recent analysis of 271 174 patients with type 2 diabetes (T2D) registered in the Swedish National Diabetes Register showed that HbA1c >7% tracks much more strongly with mortality and cardiovascular disease (CVD) outcome among people with T2D than do blood pressure or low‐density lipoprotein cholesterol . The Kaiser Permanente Northern California Diabetes Registry of 34 737 people followed for at least a decade (mean 13 years; mean age at diagnosis 57 years) found those with mean HbA1c ranging from 7.0% to <8.0% and those with HbA1c ≥9.0% had approximately 40% and 120% higher subsequent microvascular event rates, respectively, and approximately 30% and 50% higher macrovascular event rates, than those with mean HbA1c <6.5% during the first year after diagnosis . Both high HbA1c groups had approximately 30% higher mortality than those with the lower HbA1c levels .…”

mentioning

confidence: 99%

“…The Kaiser Permanente Northern California Diabetes Registry of 34 737 people followed for at least a decade (mean 13 years; mean age at diagnosis 57 years) found those with mean HbA1c ranging from 7.0% to <8.0% and those with HbA1c ≥9.0% had approximately 40% and 120% higher subsequent microvascular event rates, respectively, and approximately 30% and 50% higher macrovascular event rates, than those with mean HbA1c <6.5% during the first year after diagnosis . Both high HbA1c groups had approximately 30% higher mortality than those with the lower HbA1c levels . The implication of this and many other studies that better glycemic control is beneficial for people with T2D is inescapable.…”

mentioning

confidence: 99%

Evolution of type 2 diabetes mellitus treatment approaches

Bloomgarden

2018

Journal of Diabetes

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Updated USPSTF Screening Recommendations for Diabetes

Grant

Gopalan

Jaffe³

2021

JAMA Intern Med

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The diabetes epidemic in the US continues unabated hand in hand with the concurrent epidemics of obesity and physical inactivity. At present, there are about 34 million US adults living with type 2 diabetes (10.2% of the US adult population). Another 88 million US adults have abnormal glucose levels that fall short of a diabetes diagnosis (an additional 34.5% of the adult US population). 1,2 These numbers reflect the fact that nearly 75% of US adults have a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) in the overweight or obese range, 3 and 45% engage in no moderate-or vigorous-intensity physical activity in a typical week. 4 Despite convincing evidence supporting guidelines for lifestyle change and medical therapy, progress in the control of diabetes-related risk factors (ie, hypertension, dyslipidemia, hyperglycemia) has plateaued 5,6 or, in some cases, may have worsened. 7 As a result, millions of individuals remain at risk for the microvascular and macrovascular complications of diabetes, disability, and early mortality. The gaps in receipt of recommended care are greater for younger adults (aged 18-44 years) and members of at-risk racial and ethnic groups (American Indian/Alaska Native, Asian American, Black, Hispanic/Latinx, and Native Hawaiian/ Pacific Islander adults) than for other adults. 8 In its 2021 recommendation statement, 9 the United States Preventive Services Task Force (USPSTF) has lowered the starting age of screening for prediabetes and type 2 diabetes from 40 to 35 years for adults with overweight or obesity, while maintaining the upper age of screening at 70 years (B recommendation). The USPSTF recommends that clinicians offer or refer patients with abnormal blood glucose levels to intensive behavioral counseling interventions to promote a healthful diet and physical activity. To date, however, no high-quality clinical studies have directly shown clinical benefit from screening adults starting at age 35 years for abnormal glucose metabolism. This recommendation is therefore driven by an updated evidence report and systematic review 10 that demonstrates that screening does little direct harm, that individuals can prevent progression to diabetes with intensive lifestyle changes, and that interventions for newly diagnosed diabetes have a moderate benefit in reducing all-cause mortality, diabetes-related mortality, and risk of myocardial infarction after 10 to 20 years of intervention. Indeed, longterm follow-up of the UK Prospective Diabetes Study from the 1980s of tighter glycemic control (for that era, hemoglobin A 1c <7%) suggested that earlier rather than later glycemic control Opinion Editorial E2JAMA

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The Legacy Effect in Type 2 Diabetes: Impact of Early Glycemic Control on Future Complications (The Diabetes & Aging Study)

Cited by 442 publications

References 26 publications

Effect of diabetes duration on the relationship between glycaemic control and risk of death in older adults with type 2 diabetes

Effect of diabetes duration on the relationship between glycaemic control and risk of death in older adults with type 2 diabetes

Evolution of type 2 diabetes mellitus treatment approaches

Updated USPSTF Screening Recommendations for Diabetes

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