Glycaemic control crucial in first years after diabetes diagnosis

By Eleanor McDermid, Senior medwireNews Reporter

The largest deterioration in glycaemic control among patients with newly diagnosed Type 2 diabetes occurs in the first 2 years after diagnosis, research shows.

Therefore, “increased aggression in optimising glycaemic control during the first years after diagnosis of type 2 diabetes is crucial”, say study author Marcus Lind (University of Gothenburg, Sweden) and colleagues.

The team found that, among 4529 patients in The Health Improvement Network database who were diagnosed with diabetes in the year 2000, there was a sharp reduction in glycated haemoglobin (HbA1c) level, of about 1.5%, over the first 6 months after diagnosis.

However, the largest HbA1c rise, of 0.21% per year, occurred immediately after this, between 6 months and 2 years after diagnosis. There was a smaller 0.033% annual increase between 2 and 5 years after diagnosis, after which levels remained steady, with a nonsignificant increase of 0.0078% for the remaining 5 years of follow-up.

“The fact that the majority of the increase in HbA1c occurs during the first 2 years after onset of diabetes implies that the long-term effects of hyperglycaemia will be more pronounced than if it occurred many years after diagnosis”, write Lind et al in Diabetologia.

“Physicians therefore need to find treatment strategies to optimise the glycaemic control at an early phase in the disease.”

On multivariate analysis, the overall HbA1c increase over the 10-year follow-up was significantly higher in younger than older patients, in those with higher than lower body mass indices and in those prescribed insulin at baseline relative to those who were not. These groups therefore need “extra attention”, say the researchers.

Older patients were more likely than younger patients to have HbA1c tests at 4 and 7 months after diagnosis, although younger patients were more likely to have medication changes within 30 days of an HbA1c test above 7.0%.

The probability of medication adjustment also rose with higher HbA1c level, but was reduced in patients receiving dietary treatment and fell with increasing number of non-insulin antidiabetic medications.

“A major barrier to extending medications was treatment with two or three non-insulin glucose-lowering drugs”, observes the team. “An increased focus on adding insulin or combining several non-insulin glucose-lowering medications is warranted in this group.”

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