Factors associated with a rapid normalization of HbA1c in newly diagnosed type 2 diabetes patients seen in a specialist
- PDF / 216,798 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 29 Downloads / 192 Views
ORIGINAL ARTICLE
Factors associated with a rapid normalization of HbA1c in newly diagnosed type 2 diabetes patients seen in a specialist setting C. B. Giorda • M. F. Mulas • V. Manicardi C. Suraci • P. Guida • L. Marafetti • E. Nada • S. Gentile
•
Received: 10 January 2012 / Accepted: 5 September 2012 / Published online: 30 September 2012 Ó Springer-Verlag 2012
Abstract The time to achieve good metabolic control after diagnosis is essential for type 2 diabetes patients because it can influence long-term prognosis. This study aimed to elucidate the predictive role of several clinical and organization factors in normalizing metabolism within 6 months. A multi-centered, retrospective, observational study on 960 patients, with diabetes duration of 12 months or less, consecutively seen in 123 Italian clinics, was undertaken. Information about clinic’s organization, along with data abstracted from medical records at enrollment (first visit) and after 6 months (follow-up visit), was Communicated by Renato Lauro. This study is conducted on behalf of the SUBITO! AUDIT Study Group. For the complete details of SUBITO! AUDIT Study Group, see ‘‘Appendix’’. C. B. Giorda (&) L. Marafetti Metabolism and Diabetes Unit, ASL, Turin 5, Italy e-mail: [email protected] M. F. Mulas Metabolism and Diabetes Unit, Oristano, Italy V. Manicardi Montecchio Hospital, Montecchio Emilia, Italy C. Suraci Metabolism and Diabetes Unit, Pertini Hospital, Rome, Italy P. Guida Cardiology Unit, Emergency and Organ Transplantation Department, University of Bari, Bari, Italy E. Nada Chaira Medica Association, Chieri, Italy S. Gentile University of Naples, Naples, Italy
collected. At 6 months, HbA1c dropped by -3.1 ± 2.2 points in those who achieved HbA1c \7 % (responders), whereas in non-responders (HbA1c C7 %), the mean reduction was -1.8 ± 1.9. The intervention markedly reduced lipids, blood pressure, BMI, and waist circumference, especially in responders. The presence of a diabetes team correlated with a likelihood of HbA1c normalization (OR 1.94, 1.17–3.22). By contrast, indicators of advanced disease such as previous retinopathy (0.53, 0.29–0.98), use of secretagogues (0.40, 0.25–0.64), high levels of HbA1c at first visit and related insulin use emerged as adverse factors. Early detection of diabetes, along with human resources and organization, was found to play a crucial role in rapidly attaining good metabolic control. Keywords HbA1c normalization Type 2 diabetes treatment Organizational factors Clinical factors
Introduction The goals and modes of diabetes mellitus treatment have evolved rapidly in recent years. There is now well-established clinical and laboratory evidence for the legacy effect, that is, diabetic vascular stress persisting after glucose normalization. Randomized clinical trials such as DCCT-EDIC [1], UKPDS 80 [2], and STENO 2 [3] have consistently reported a better prognosis in patients who begin intensive therapy early after diagnosis than in those who achieve better HbA1c levels later in the course of treatment. Furth
Data Loading...
