Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Diabetes Obes Metab. 2018 Aug;20(8):1957-1964. doi: 10.1111/dom.13332. Epub 2018 May 24.
To identify subgroups of patients with type 2 diabetes mellitus (T2DM) following distinct trajectories of HbA1c after insulin initiation and explore underlying differences in clinical characteristics.
A cohort study was conducted in patients with T2DM initiating insulin in 2007-2013 with a follow-up of 2 to 4 years. Data were collected from the Groningen Initiative to Analyze Type 2 Diabetes Treatment (GIANTT) database. The primary outcome was subgroups with different trajectories of HbA1c patterns after insulin initiation, as identified by latent class growth modeling. Differences between subgroups were tested using one-way ANOVA, Kruskal-Wallis or chi-square tests, where appropriate.
From 1459 patients, three subgroups with distinct HbA1c patterns were identified. Group 1 (8%) initially showed a moderate decrease followed by an increase in HbA1c 2 years later, despite receiving more comedication. Group 2 (84%) showed a stable decrease. Group 3 (8%) had a high initial level of HbA1c and a rapid decline within the first year, followed by a slow increase thereafter. Group 1 patients were on average 6-7 years younger than patients in groups 2 and 3 and were more likely to receive sulfonylureas than Group 3 patients. Group 3 patients had a shorter diabetes duration and were less well-controlled for HbA1c, systolic blood pressure and LDL-cholesterol at insulin initiation.
Most patients showed a stable HbA1c response, but one out of six patients showed either a poor response, or a rapid initial response only after insulin initiation. Response patterns were associated with age, diabetes duration and risk-factor controls at the time of insulin initiation.
鉴定在起始胰岛素治疗后糖化血红蛋白（HbA1c）呈现不同轨迹的 2 型糖尿病（T2DM）患者亚组，并探讨其临床特征的潜在差异。
这是一项 2007-2013 年起始胰岛素治疗的 T2DM 患者的队列研究，随访时间为 2-4 年。数据来自格罗宁根分析 2 型糖尿病治疗（GIANTT）数据库。主要结局是通过潜在类别增长模型确定胰岛素起始后 HbA1c 模式的不同轨迹的亚组。使用单因素方差分析、Kruskal-Wallis 检验或卡方检验（视情况而定）来检验亚组之间的差异。
从 1459 名患者中，确定了具有不同 HbA1c 模式的三个亚组。第 1 组（8%）最初表现为 HbA1c 中度下降，随后 2 年后出现升高，尽管接受了更多联合用药。第 2 组（84%）表现出稳定下降。第 3 组（8%）HbA1c 初始水平较高，且在第一年迅速下降，随后缓慢升高。第 1 组患者的平均年龄比第 2 组和第 3 组患者年轻 6-7 岁，且比第 3 组患者更可能接受磺脲类药物。第 3 组患者的糖尿病病程较短，且在起始胰岛素治疗时，HbA1c、收缩压和 LDL-胆固醇的控制较差。
大多数患者的 HbA1c 反应稳定，但六分之一的患者要么反应不佳，要么仅在起始胰岛素治疗后出现快速初始反应。反应模式与起始胰岛素治疗时的年龄、糖尿病病程和危险因素控制有关。
