title: Impact of diagnosing diabetic complications on future hemoglobin A1c levels.
abstract: OBJECTIVE
  To assess how hemoglobin A1c (HbA1c) values might change following the diagnosis of the first complication from diabetes mellitus (DM).
  
  
  METHODS
  Using a nationwide, longitudinal managed care network claims database (2001-2011), we identified patients with DM who experienced an initial diabetes-related complication. A paired t-test was used to compare average HbA1c levels before the initial complication was first diagnosed to average HbA1c levels following the diagnosis of the complication.
  
  
  RESULTS
  518 enrollees met study inclusion criteria. Patients with suboptimally controlled DM (defined as HbA1c>7% (53 mmol/mol)) prior to the diagnosis of their first diabetic complication demonstrated a clinically significant reduction in average HbA1c following the diagnosis of their first complication (mean pre-complication HbA1c=8.5 ± 1.5% (69 ± 17 mmol/mol) vs. mean post-complication HbA1c=7.9 ± 1.7% (63 ± 18 mmol/mol) (p<0.0001)).
  
  
  CONCLUSIONS
  Enrollees with suboptimally controlled DM may achieve better glycemic control following the diagnosis of a complication from DM. The results from this study, if confirmed in prospective studies, may provide a rationale for the earlier detection of complications from DM to facilitate improved glycemic control among patients with DM.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, USA.
authors.forename: Maxwell S
authors.initials: MS
authors.lastname: Stem
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, USA.
authors.forename: Taylor S
authors.initials: TS
authors.lastname: Blachley
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, USA.
authors.forename: Roni M
authors.initials: RM
authors.lastname: Shtein
authors.affiliation: Department of Internal Medicine, University of Michigan Medical School, USA; Department of Epidemiology, University of Michigan, USA; Institute for Healthcare Policy and Innovation, University of Michigan, USA.
authors.forename: William H
authors.initials: WH
authors.lastname: Herman
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, USA.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Gardner
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, USA; Institute for Healthcare Policy and Innovation, University of Michigan, USA. Electronic address: jdstein@med.umich.edu.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Stein
mesh_terms: D000368:Aged; D016208:Databases, Factual / Q000706:statistics & numerical data; D048909:Diabetes Complications / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D007345:Insurance Claim Review; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Change in hemoglobin A(1c); Diabetes mellitus; Diabetic retinopathy; First complication; Glycemic control