title: Ten-year hemoglobin A1c trajectories and outcomes in type 2 diabetes mellitus: The Diabetes & Aging Study.
abstract: To classify trajectories of long term HbA1c values in patients after diagnosis of type 2 diabetes and examine each trajectory's associations with subsequent microvascular and macrovascular events and mortality.
  
  
  
  A longitudinal follow-up of 28,016 patients newly diagnosed with type 2 diabetes was conducted. Latent growth mixture modeling was used to identify ten-year HbA1c trajectories. Cox proportional hazards models were used to assess how HbA1c trajectories were associated with events (microvascular and macrovascular) and mortality.
  
  
  
  We identified 5 HbA1c trajectories: "low stable" (82.5%), "moderate increasing late" (5.1%), "high decreasing early" (4.9%), "moderate peaking late" (4.1%) and "moderate peaking early" (3.3%). After adjusting for average HbA1c, compared to the low stable trajectory, all non-stable trajectories were associated with higher incidences of microvascular events (hazard ratio (HR) range, 1.28 (95% CI, 1.08-1.53) (high decreasing early) to 1.45 (95% CI, 1.20-1.75) (moderate peaking early)). The high decreasing early trajectory was associated with an increased mortality risk (HR, 1.27 (95% CI, 1.03-1.58)). Trajectories were not associated with macrovascular events.
  
  
  
  Non-stable HbA1c trajectories were associated with greater risk of microvascular events and mortality. These findings suggest a potential benefit of early diabetes detection, prioritizing good glycemic control, and maintaining control over time.
authors: Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 S Maryland Avenue, MC 2007, Chicago, IL 60637, USA. Electronic address: nlaiteer@medicine.bsd.uchicago.edu.
authors: Neda
authors: N
authors: Laiteerapong
authors: Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, USA.
authors: Andrew J
authors: AJ
authors: Karter
authors: Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, USA.
authors: Howard H
authors: HH
authors: Moffet
authors: Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 S Maryland Avenue, MC 2007, Chicago, IL 60637, USA.
authors: Jennifer M
authors: JM
authors: Cooper
authors: Departments of Medicine and Public Health Sciences, University of Chicago, 5841 S Maryland Avenue, MC 2000, Chicago, IL 60637, USA.
authors: Robert D
authors: RD
authors: Gibbons
authors: Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, USA.
authors: Jennifer Y
authors: JY
authors: Liu
authors: Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 S Maryland Avenue, MC 2007, Chicago, IL 60637, USA.
authors: Yue
authors: Y
authors: Gao
authors: Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 S Maryland Avenue, MC 2007, Chicago, IL 60637, USA.
authors: Elbert S
authors: ES
authors: Huang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000097:blood* / Q000502:physiology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000175:diagnosis* / Q000473:pathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis* / Q000378:metabolism; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis
chemical_list: D006442:Glycated Hemoglobin
keywords: Epidemiology; Glycemic control; Legacy effect; Microvascular disease; Mortality