Diabetes Metab J.  2017 Aug;41(4):284-295. 10.4093/dmj.2017.41.4.284.

Determinants of Long-Term Durable Glycemic Control in New-Onset Type 2 Diabetes Mellitus

• Kim KJ
• Choi JH
• Kim KJ
• An JH
• Kim HY
• Kim SG
• Kim NH

• KMID: 2392469
• DOI: http://doi.org/10.4093/dmj.2017.41.4.284

Abstract

BACKGROUND
Long-term durable glycemic control is a difficult goal in the management of type 2 diabetes mellitus (T2DM). We evaluated the factors associated with durable glycemic control in a real clinical setting.
METHODS
We retrospectively reviewed the medical records of 194 new-onset, drug-naïve patients with T2DM who were diagnosed between January 2011 and March 2013, and were followed up for >2 years. Glycemic durability was defined as the maintenance of optimal glycemic control (glycosylated hemoglobin [HbA1c] <7.0%) for 2 years without substitution or adding other glucose-lowering agents. Clinical factors and glycemic markers associated with glycemic durability were compared between two groups: a durability group and a non-durability group.
RESULTS
Patients in the durability group had a higher baseline body mass index (26.1 kg/m² vs. 24.9 kg/m²) and lower HbA1c (8.6% vs. 9.7%) than the non-durability group. The initial choice of glucose-lowering agents was similar in both groups, except for insulin and sulfonylureas, which were more frequently prescribed in the non-durability group. In multiple logistic regression analyses, higher levels of education, physical activity, and homeostasis model assessment of β-cell function (HOMA-β) were associated with glycemic durability. Notably, lower HbA1c (<7.0%) at baseline and first follow-up were significantly associated with glycemic durability (adjusted odds ratio [OR], 7.48; 95% confidence interval [CI], 2.51 to 22.3) (adjusted OR, 9.27; 95% CI, 1.62 to 53.1, respectively), after adjusting for confounding variables including the types of glucose-lowering agents.
CONCLUSION
Early achievement of HbA1c level within the glycemic target was a determinant of long-term glycemic durability in new-onset T2DM, as were higher levels of education, physical activity, and HOMA-β.

Keyword

Diabetes mellitus, type 2; Durability; Glycemic control

MeSH Terms

Body Mass Index
Confounding Factors (Epidemiology)
Diabetes Mellitus, Type 2*
Follow-Up Studies
Homeostasis
Humans
Insulin
Logistic Models
Medical Records
Odds Ratio
Physical Education and Training
Retrospective Studies
Insulin

Figure

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  Fig. 1 Changes in the mean glycosylated hemoglobin (HbA1c) levels during the 2-year follow-up period. aDifference between groups P<0.01.

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  Fig. 2 The frequency of glycemic durability and non-durability according to the baseline glycosylated hemoglobin (HbA1c) levels (P<0.005).

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  Fig. 3 The frequency of glycemic durability and non-durability according to the glycosylated hemoglobin (HbA1c) level at the first follow-up visit (P<0.001).

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