Effect of glycemic control on the Diabetes Complications Severity Index score and development of complications in people with newly diagnosed type 2 diabetes: 在新诊断的2型糖尿病患者中血糖控制情况对糖尿病并发症严重程度指数评分以及并发症进展的影响. Issue 3 (27th November 2017)

• Record Type: Journal Article
• Authors: Pantalone, Kevin M.; Misra‐Hebert, Anita D.; Hobbs, Todd M.; Wells, Brian J.; Kong, Sheldon X.; Chagin, Kevin; Dey, Tanujit; Milinovich, Alex; Weng, Wayne; Bauman, Janine M.; Burguera, Bartolome; Zimmerman, Robert S.; Kattan, Michael W.
• Is Part Of: Journal of diabetes. Volume 10:Issue 3(2018)
• Page Start: 192
• Page End: 199
• Publication Date: 2017-11-27
• Subjects: Diabetes Complications Severity Index -- electronic health records -- HbA1c -- longitudinal -- type 2 diabetes; 糖尿病并发症严重程度指数 -- 电子健康档案 -- HbA1c -- 纵向 -- 2型糖尿病; Diabetes -- Periodicals; 618.3646005
• DOI: 10.1111/1753-0407.12613
• Languages: English
• ISSNs: 1753-0393

Abstract

Abstract: Background: The aim of the present study was to assess the longitudinal accumulation of diabetes‐related complications and the effect of glycemic control on the Diabetes Complications Severity Index (DCSI) score in people with newly diagnosed type 2 diabetes (T2D). Methods: A retrospective cohort study was conducted using electronic health records from a large integrated healthcare system. People with newly diagnosed T2D were identified between 2005 and 2016 and stratified by initial HbA1c category (<7%, <8%, ≥8%). The DCSI scores were determined for each study year, and the cumulative incidence of diabetes‐related complications was assessed. A Cox proportional hazard model was used to evaluate the effect of baseline HbA1c and worsening glycemic (HbA1c) control on longitudinal changes in DCSI scores. Results: Of 32 174 people identified as having newly diagnosed T2D, 14 016 (44%), 21 657 (67%), and 9983 (31%) had an initial or baseline HbA1c <7%, <8%, and ≥8%, respectively. Ten years after diabetes diagnosis, retinopathy, chronic kidney disease, coronary heart disease, and neuropathy were diagnosed in 22%, 29%, 24%, and 36% of people. Baseline HbA1c did not affect the observed trend in longitudinal changes in DCSI scores throughout the 11‐year period. For people in each of the initial HbA1c groups (<7%, <8%, ≥8%), worsening or persistently poor glycemic control was significantly associated with a 10%, 19%, or 16% increase in the risk of experiencing an increased DCSI score, respectively (all P < 0.01). Conclusions: Baseline glycemic control had no apparent effect on longitudinal changes in DCSI score. Worsening or persistently poor glycemic control was associated with an increased risk of an increase in the DCSI score. Abstract : Highlights There is a lack of published real‐world evidence regarding longitudinal changes in Diabetes Complications Severity Index (DCSI) scores among people with newly diagnosed type 2 diabetes (T2D), including how the level of glycemic control at the time of diagnosis may affect DCSI score progression. This study evaluated such outcomes over an 11‐year period in a very large cohort of patients with newly diagnosed T2D (n = 32 174), with data drawn from electronic health records from a large US integrated healthcare system. These are the first known data to demonstrate that worsening or persistently poor glycemic control, but not baseline glycemic control, is associated with increasing DCSI score over time.