title: Metabolic memory and all-cause death in community-based patients with type 2 diabetes: the Fremantle Diabetes Study.
abstract: To validate the findings, in a usual care setting, of glycaemic intervention trials, which have shown that tight control in patients with recently diagnosed type 2 diabetes protects against death during post-study monitoring, but that it may be deleterious in long-duration diabetes with vascular complications.
  
  
  
  A subset of 531 patients with type 2 diabetes from the community-based observational Fremantle Diabetes Study Phase 1, who attended ≥5 annual reviews (mean follow-up 15.9 years), were categorized by baseline diabetes duration [<1 year (Group 1); 1 to <5 years (Group 2); and ≥5 years (Group 3)]. Glycated haemoglobin (HbA1c) trajectories over the first 5 years were determined [low, medium and high; equivalent to mean HbA1c ≤6.6% (<49 mmol/mol), 6.7-8.0% (50-64 mmol/mol) and ≥8.0% (>64 mmol/mol), respectively]. Kaplan-Meier analysis was used to assess survival by duration and HbA1c trajectory. Cox proportional hazards modelling identified predictors of all-cause death.
  
  
  
  There was greater mortality in patients with a medium versus those with a low trajectory in Group 1: hazard ratio (HR) 1.99 [95% confidence interval (CI) 1.003-3.94; p = 0.049], and in patients with a high versus a low trajectory in Group 2: HR 2.02 (95% CI 1.11-3.71; p = 0.022). In Group 3, both medium [HR 0.57 (95% CI 0.35-0.92; p = 0.022)] and high [HR 0.56 (95% CI 0.32-0.96); p = 0.035] trajectories were independently and inversely associated with death.
  
  
  
  In community-based patients with newly or recently diagnosed type 2 diabetes, poor glycaemic control was an adverse prognostic indicator. Tight control was independently associated with death in patients with diabetes duration ≥5 years. These data parallel intervention trial findings and support individualization of HbA1c targets.
authors.affiliation: School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, Western Australia, Australia.
authors.forename: T M E
authors.initials: TM
authors.lastname: Davis
authors.affiliation: School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, Western Australia, Australia.|Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, Royal Perth Hospital, Perth, Western Australia, Australia.|School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, Western Australia, Australia.|Department of Clinical Biochemistry, PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
authors.forename: S A P
authors.initials: SA
authors.lastname: Chubb
authors.affiliation: School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, Western Australia, Australia.
authors.forename: D G
authors.initials: DG
authors.lastname: Bruce
authors.affiliation: School of Medicine and Pharmacology, Fremantle Hospital, Fremantle, Western Australia, Australia.
authors.forename: W A
authors.initials: WA
authors.lastname: Davis
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D002423:Cause of Death; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D057187:Independent Living / Q000706:statistics & numerical data; D008134:Long-Term Care / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: glycaemic control; observational study; type 2 diabetes