Metabolic memory and all-cause death in community-based patients with type 2 diabetes: the Fremantle Diabetes Study

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    Abstract

    Aims: To validate the findings, in a usual care setting, of glycaemic intervention trials, which have shown that tight control in patients with recently diagnosed type 2 diabetes protects against death during post-study monitoring, but that it may be deleterious in long-duration diabetes with vascular complications.Methods: A subset of 531 patients with type 2 diabetes from the community-based observational Fremantle Diabetes Study Phase 1, who attended >= 5 annual reviews (mean follow-up 15.9 years), were categorized by baseline diabetes duration [= 5 years (Group 3)]. Glycated haemoglobin (HbA1c) trajectories over the first 5 years were determined [low, medium and high; equivalent to mean HbA1c = 8.0% (>64 mmol/mol), respectively]. Kaplan-Meier analysis was used to assess survival by duration and HbA1c trajectory. Cox proportional hazards modelling identified predictors of all-cause death.Results: There was greater mortality in patients with a medium versus those with a low trajectory in Group 1: hazard ratio (HR) 1.99 [95% confidence interval (CI) 1.003-3.94; p = 0.049], and in patients with a high versus a low trajectory in Group 2: HR 2.02 (95% CI 1.11-3.71; p = 0.022). In Group 3, both medium [HR 0.57 (95% CI 0.35-0.92; p = 0.022)] and high [HR 0.56 (95% CI 0.32-0.96); p = 0.035] trajectories were independently and inversely associated with death.Conclusions: In community-based patients with newly or recently diagnosed type 2 diabetes, poor glycaemic control was an adverse prognostic indicator. Tight control was independently associated with death in patients with diabetes duration >= 5 years. These data parallel intervention trial findings and support individualization of HbA1c targets.
    Original languageEnglish
    Pages (from-to)598-606
    JournalDiabetes, Obesity and Metabolism
    Volume18
    Issue number6
    Early online date12 Apr 2016
    DOIs
    Publication statusPublished - Jun 2016

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