title: Changes in HbA1c and frequency of measuring HbA1c and adjusting glucose-lowering medications in the 10 years following diagnosis of type 2 diabetes: a population-based study in the UK.
abstract: OBJECTIVE
  The aim of this work was to study levels of HbA1c and patterns of adjusting glucose-lowering drugs in patients with impaired glycaemic control over 10 years after diagnosis of type 2 diabetes.
  
  
  METHODS
  We studied 4,529 individuals in The Health Improvement Network Database newly diagnosed with type 2 diabetes in the year 2000.
  
  
  RESULTS
  From 6 months to 10 years after diagnosis, the HbA1c increased from 7.04% (53.4 mmol/mol) to 7.49% (58.3 mmol/mol) (average annual change: 0.047% [0.51 mmol/mol]). The greatest annual change occurred between 6 months and 2 years (0.21% [2.30 mmol/mol] increase per year, p < 0.001), followed by the 2-5 year time period (0.033% [0.36 mmol/mol] increase per year, p < 0.001). No significant increase in HbA1c occurred between 5 and 10 years (p = 0.20). In multivariable analyses, patients who were younger (p < 0.001), with higher BMI (p = 0.033) and who were current insulin users (p = 0.024) at diagnosis had greater increases in HbA1c between 6 months and 2 years. For individuals with HbA1c above 7.0% (53 mmol/mol) the mean time to next measurement of HbA1c was 0.53 years and increase in doses or changes to other glucose-lowering medications were performed in 26% of cases.
  
  
  CONCLUSIONS
  HbA1c increases by approximately 0.5% (5 mmol/mol) over 10 years after diagnosis of type 2 diabetes, with the main increase appearing in the first years after diagnosis. More frequent monitoring of HbA1c and adjustments of glucose-lowering drugs may be essential to prevent the decline.
authors.affiliation: Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, lind.marcus@telia.com.
authors.forename: Marcus
authors.initials: M
authors.lastname: Lind
authors.forename: Aldina
authors.initials: A
authors.lastname: Pivodic
authors.forename: Lucia
authors.initials: L
authors.lastname: Cea-Soriano
authors.forename: Olle
authors.initials: O
authors.lastname: Nerman
authors.forename: Nils-Gunnar
authors.initials: NG
authors.lastname: Pehrsson
authors.forename: Luis A
authors.initials: LA
authors.lastname: Garcia-Rodriguez
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents