Rates of glycaemic deterioration in a real-world population with type 2 diabetes

Louise A. Donnelly; Kaixin Zhou; Alex S. F. Doney; Chris  Jennison; Paul W. Franks; Ewan R. Pearson

doi:10.1007/s00125-017-4519-5

Rates of glycaemic deterioration in a real-world population with type 2 diabetes

Louise A. Donnelly, Kaixin Zhou, Alex S. F. Doney, Chris Jennison, Paul W. Franks, Ewan R. Pearson (Lead / Corresponding author)

Research output: Contribution to journal › Article › peer-review

39 Citations (Scopus)

230 Downloads (Pure)

Abstract

Aims/hypothesis: There is considerable variability in how diabetes progresses after diagnosis. Progression modelling has largely focused on ‘time to failure’ methods, yet determining a ‘coefficient of failure’ has many advantages. We derived a rate of glycaemic deterioration in type 2 diabetes, using a large real-world patient cohort, and aimed to investigate the clinical, biochemical, pharmacological and immunological parameters associated with fast and slow rates of glycaemic deterioration.
Methods: An observational cohort study was performed utilising the electronic medical records from patients in the Genetics of Diabetes Audit and Research in Tayside Study (GoDARTS). A model was derived based on a patient’s observed HbA1c measures from first eligible HbA1c after diabetes diagnosis through to study end (defined as insulin initiation, death, leaving area or end of follow-up). Each HbA1c measure was adjusted time-dependently for the effects of non-insulin antidiabetic drugs, changes in BMI and corticosteroid use. GADA positivity was defined as GAD titres >97.5th centile of the population distribution.
Results: The mean glycaemic deterioration for patients with type 2 diabetes and GADA positive patients was 0.12(95%CI 0.12,0.13)% and 0.25(0.20,0.31)% HbA1c per year respectively. A younger age of diagnosis, lower HDL, higher BMI and earlier calendar year of diabetes diagnosis were independently associated with higher rates of glycaemic deterioration in patients with type 2 diabetes. The rate of deterioration in those diagnosed over 70 years of age was very low; with 66% having a rate of deterioration less than 0.1% HbA1c per year, and only 1.5% progressing more rapidly than 0.4% HbA1c per year.
Conclusions/interpretation: We have developed a novel approach to model diabetes progression in observational data across multiple drug combinations. This approach highlights how glycaemic deterioration in those diagnosed over 70 years of age is minimal supporting a stratified approach to diabetes management.

Original language	English
Pages (from-to)	607-615
Number of pages	9
Journal	Diabetologia
Volume	61
Early online date	19 Dec 2017
DOIs	https://doi.org/10.1007/s00125-017-4519-5
Publication status	Published - 19 Dec 2017

Keywords

Coefficient of failure
Elderly
Electronic medical records
Glycaemic deterioration
Observational
Type 2 diabetes

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1007/s00125-017-4519-5Licence: CC BY

Final Published Version
© The Author(s) 2017. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Final published version, 767 KBLicence: CC BY

1 Finished
1 Active

DIRECT: Diabetes Research on Patient Stratification (joint with 25 other partners)
Colhoun, H. (Investigator), Houston, G. (Investigator), Morris, A. (Investigator), Palmer, C. (Investigator) & Pearson, E. (Investigator)
COMMISSION OF THE EUROPEAN COMMUNITIES
1/02/12 → 28/02/27
Project: Research
Stratified Medicine in Type 2 Diabetes: Insights from the Study of Drug Response (New Investigator Award)
Pearson, E. (Investigator)
16/02/15 → 15/08/21
Project: Research

Pearson, Ewan
- Diabetes Endocrinology and Reproductive Biology - Clinical Professor (Teaching and Research) of Diabetic Medicine
Person: Academic

Health Informatics Centre
Health and Clinical Services
Facility/equipment: Facility

Cite this

@article{9a773edb0da84a7a8064221bfb97a692,

title = "Rates of glycaemic deterioration in a real-world population with type 2 diabetes",

abstract = "Aims/hypothesis: There is considerable variability in how diabetes progresses after diagnosis. Progression modelling has largely focused on {\textquoteleft}time to failure{\textquoteright} methods, yet determining a {\textquoteleft}coefficient of failure{\textquoteright} has many advantages. We derived a rate of glycaemic deterioration in type 2 diabetes, using a large real-world patient cohort, and aimed to investigate the clinical, biochemical, pharmacological and immunological parameters associated with fast and slow rates of glycaemic deterioration.Methods: An observational cohort study was performed utilising the electronic medical records from patients in the Genetics of Diabetes Audit and Research in Tayside Study (GoDARTS). A model was derived based on a patient{\textquoteright}s observed HbA1c measures from first eligible HbA1c after diabetes diagnosis through to study end (defined as insulin initiation, death, leaving area or end of follow-up). Each HbA1c measure was adjusted time-dependently for the effects of non-insulin antidiabetic drugs, changes in BMI and corticosteroid use. GADA positivity was defined as GAD titres >97.5th centile of the population distribution.Results: The mean glycaemic deterioration for patients with type 2 diabetes and GADA positive patients was 0.12(95%CI 0.12,0.13)% and 0.25(0.20,0.31)% HbA1c per year respectively. A younger age of diagnosis, lower HDL, higher BMI and earlier calendar year of diabetes diagnosis were independently associated with higher rates of glycaemic deterioration in patients with type 2 diabetes. The rate of deterioration in those diagnosed over 70 years of age was very low; with 66% having a rate of deterioration less than 0.1% HbA1c per year, and only 1.5% progressing more rapidly than 0.4% HbA1c per year.Conclusions/interpretation: We have developed a novel approach to model diabetes progression in observational data across multiple drug combinations. This approach highlights how glycaemic deterioration in those diagnosed over 70 years of age is minimal supporting a stratified approach to diabetes management.",

keywords = "Coefficient of failure , Elderly , Electronic medical records , Glycaemic deterioration , Observational , Type 2 diabetes ",

author = "Donnelly, {Louise A.} and Kaixin Zhou and Doney, {Alex S. F.} and Chris Jennison and Franks, {Paul W.} and Pearson, {Ewan R.}",

note = "The work leading to this publication has received support from the Innovative Medicines Initiative Joint Undertaking under grant agreement n°115317 (DIRECT), resources of which are composed of financial contribution from the European Union's Seventh Framework Programme (FP7/2007-2013) and EFPIA companies{\textquoteright} in kind contribution (http://www.direct-diabetes.org/). EP holds a Wellcome Trust New Investigator Award (102820/Z/13/Z).",

year = "2017",

month = dec,

day = "19",

doi = "10.1007/s00125-017-4519-5",

language = "English",

volume = "61",

pages = "607--615",

journal = "Diabetologia",

issn = "0012-186X",

publisher = "Springer Science and Business Media Deutschland GmbH",

}

TY - JOUR

T1 - Rates of glycaemic deterioration in a real-world population with type 2 diabetes

AU - Donnelly, Louise A.

AU - Zhou, Kaixin

AU - Doney, Alex S. F.

AU - Jennison, Chris

AU - Franks, Paul W.

AU - Pearson, Ewan R.

N1 - The work leading to this publication has received support from the Innovative Medicines Initiative Joint Undertaking under grant agreement n°115317 (DIRECT), resources of which are composed of financial contribution from the European Union's Seventh Framework Programme (FP7/2007-2013) and EFPIA companies’ in kind contribution (http://www.direct-diabetes.org/). EP holds a Wellcome Trust New Investigator Award (102820/Z/13/Z).

PY - 2017/12/19

Y1 - 2017/12/19

N2 - Aims/hypothesis: There is considerable variability in how diabetes progresses after diagnosis. Progression modelling has largely focused on ‘time to failure’ methods, yet determining a ‘coefficient of failure’ has many advantages. We derived a rate of glycaemic deterioration in type 2 diabetes, using a large real-world patient cohort, and aimed to investigate the clinical, biochemical, pharmacological and immunological parameters associated with fast and slow rates of glycaemic deterioration.Methods: An observational cohort study was performed utilising the electronic medical records from patients in the Genetics of Diabetes Audit and Research in Tayside Study (GoDARTS). A model was derived based on a patient’s observed HbA1c measures from first eligible HbA1c after diabetes diagnosis through to study end (defined as insulin initiation, death, leaving area or end of follow-up). Each HbA1c measure was adjusted time-dependently for the effects of non-insulin antidiabetic drugs, changes in BMI and corticosteroid use. GADA positivity was defined as GAD titres >97.5th centile of the population distribution.Results: The mean glycaemic deterioration for patients with type 2 diabetes and GADA positive patients was 0.12(95%CI 0.12,0.13)% and 0.25(0.20,0.31)% HbA1c per year respectively. A younger age of diagnosis, lower HDL, higher BMI and earlier calendar year of diabetes diagnosis were independently associated with higher rates of glycaemic deterioration in patients with type 2 diabetes. The rate of deterioration in those diagnosed over 70 years of age was very low; with 66% having a rate of deterioration less than 0.1% HbA1c per year, and only 1.5% progressing more rapidly than 0.4% HbA1c per year.Conclusions/interpretation: We have developed a novel approach to model diabetes progression in observational data across multiple drug combinations. This approach highlights how glycaemic deterioration in those diagnosed over 70 years of age is minimal supporting a stratified approach to diabetes management.

AB - Aims/hypothesis: There is considerable variability in how diabetes progresses after diagnosis. Progression modelling has largely focused on ‘time to failure’ methods, yet determining a ‘coefficient of failure’ has many advantages. We derived a rate of glycaemic deterioration in type 2 diabetes, using a large real-world patient cohort, and aimed to investigate the clinical, biochemical, pharmacological and immunological parameters associated with fast and slow rates of glycaemic deterioration.Methods: An observational cohort study was performed utilising the electronic medical records from patients in the Genetics of Diabetes Audit and Research in Tayside Study (GoDARTS). A model was derived based on a patient’s observed HbA1c measures from first eligible HbA1c after diabetes diagnosis through to study end (defined as insulin initiation, death, leaving area or end of follow-up). Each HbA1c measure was adjusted time-dependently for the effects of non-insulin antidiabetic drugs, changes in BMI and corticosteroid use. GADA positivity was defined as GAD titres >97.5th centile of the population distribution.Results: The mean glycaemic deterioration for patients with type 2 diabetes and GADA positive patients was 0.12(95%CI 0.12,0.13)% and 0.25(0.20,0.31)% HbA1c per year respectively. A younger age of diagnosis, lower HDL, higher BMI and earlier calendar year of diabetes diagnosis were independently associated with higher rates of glycaemic deterioration in patients with type 2 diabetes. The rate of deterioration in those diagnosed over 70 years of age was very low; with 66% having a rate of deterioration less than 0.1% HbA1c per year, and only 1.5% progressing more rapidly than 0.4% HbA1c per year.Conclusions/interpretation: We have developed a novel approach to model diabetes progression in observational data across multiple drug combinations. This approach highlights how glycaemic deterioration in those diagnosed over 70 years of age is minimal supporting a stratified approach to diabetes management.

KW - Coefficient of failure

KW - Elderly

KW - Electronic medical records

KW - Glycaemic deterioration

KW - Observational

KW - Type 2 diabetes

U2 - 10.1007/s00125-017-4519-5

DO - 10.1007/s00125-017-4519-5

M3 - Article

C2 - 29260253

SN - 0012-186X

VL - 61

SP - 607

EP - 615

JO - Diabetologia

JF - Diabetologia

ER -

Rates of glycaemic deterioration in a real-world population with type 2 diabetes

Abstract

Keywords

UN SDGs

Access to Document

Fingerprint

Projects

DIRECT: Diabetes Research on Patient Stratification (joint with 25 other partners)

Stratified Medicine in Type 2 Diabetes: Insights from the Study of Drug Response (New Investigator Award)

Profiles

Pearson, Ewan

Equipment

Health Informatics Centre

Cite this