Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey.
Medicine (Baltimore). 2023 Dec 15;102(50):e36680. doi: 10.1097/MD.0000000000036680.
Patients with type 2 diabetes who have HbA1c values ≥ 10% have different previous glycemic trends, including new diagnosis of diabetes. We aimed to assess the efficacy of 3 months of intensive and facilitated antihyperglycemic treatment in patients with different glycemic backgrounds. In this observational study, patients with type 2 diabetes and poor glycemic control (indicated by an HbA1c level of > = 10%) were divided into groups based on their previous HbA1c levels (group 1; newly diagnosed type 2 diabetics, group 2; patients with previously controlled but now deteriorated HbA1c levels, group 3; patients whose HbA1c was not previously in the target range but was now above 10%, and group 4; patients whose HbA1c was above 10% from the start). Patients received intensive diabetes management with close monitoring and facilitated hospital visits. For further analysis, patients who were known to have previously had good metabolic control (either did not have diabetes or had previously had an HbA1c value < =7) and patients who had prior poor metabolic control were analyzed separately. Of the 195 participants [female, n = 84 (43.1%)], the median age was 54 years (inter-quantile range [IQR] = 15, min = 29, max = 80) and the median baseline HbA1c was 11.8% (IQR = 2.6%, min = 10%, max = 18.3%). The median duration of diabetes was 10 years (IQR = 9, min = 1, max = 35) when newly diagnosed patients were excluded. The ≥ 20% reduction in HbA1c at month 3 was observed in groups 1 to 4 in 97%, 88.1%, 69.1%, and 55.4%, respectively. The percentage of patients who achieved an HbA1c level of 7% or less was 60.6%, 38.1%, 16.4%, and 6.2% in the groups, respectively. The rate of those who achieved an HbA1c of 7% or less was nearly 50% of patients with type 2 diabetes mellitus who had previously had good metabolic control, whereas successful control was achieved in only 1 in 10 patients with persistently high HbA1c levels. Patients' glycemic history played an important role in determining their HbA1c levels at 3 months, suggesting that previous glycemic management patterns may indicate future success in diabetes control.
患者 2 型糖尿病糖化血红蛋白值 ≥10%，其既往血糖趋势不同，包括新诊断的糖尿病。我们旨在评估 3 个月强化和便利降糖治疗对不同血糖背景患者的疗效。在这项观察性研究中，将血糖控制不佳（糖化血红蛋白水平＞＝10%）的 2 型糖尿病患者根据既往糖化血红蛋白水平分为组（组 1：新诊断的 2 型糖尿病患者，组 2：既往血糖控制但现在恶化的患者，组 3：既往糖化血红蛋白未达标但现在高于 10%的患者，组 4：从一开始糖化血红蛋白就高于 10%的患者）。患者接受强化糖尿病管理，密切监测并方便就诊。为了进一步分析，我们分别分析了已知既往代谢控制良好（要么没有糖尿病，要么既往糖化血红蛋白＜＝7）和既往代谢控制不佳的患者。在 195 名参与者中[女性，n＝84（43.1%）]，中位年龄为 54 岁（四分位间距[IQR]＝15，最小值＝29，最大值＝80），中位基线糖化血红蛋白为 11.8%（IQR＝2.6%，最小值＝10%，最大值＝18.3%）。排除新诊断患者后，中位糖尿病病程为 10 年（IQR＝9，最小值＝1，最大值＝35）。第 3 个月时，组 1 至 4 的糖化血红蛋白降幅≥20%的患者分别占 97%、88.1%、69.1%和 55.4%。组内分别有 60.6%、38.1%、16.4%和 6.2%的患者达到糖化血红蛋白＜7%的目标。在既往代谢控制良好的 2 型糖尿病患者中，有近 50%的患者达到了糖化血红蛋白＜7%的目标，而在持续高糖化血红蛋白水平的患者中，只有 1 成患者能够成功控制。患者的血糖史在确定 3 个月时的糖化血红蛋白水平方面起着重要作用，表明既往血糖管理模式可能预示着未来糖尿病控制的成功。
