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 journalArticlepeer-review

35 Citations (Scopus)
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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 languageEnglish
Pages (from-to)607-615
Number of pages9
Early online date19 Dec 2017
Publication statusPublished - 19 Dec 2017


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


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