Newly Diagnosed Type 2 Diabetes: Factors Contributing to Diabetes Control over Time

Presentation Number: MON 627
Date of Presentation: April 3rd, 2017

Michael Morkos*1 and Leon Fogelfeld2
1Rush University Medical Center, Chicago, IL, 2John H. Stroger, Jr. Hospital of Cook County, Chicago, IL

Abstract

Objective: To characterize the factors contributing to the control over time of newly diagnosed type 2 diabetes patients in underserved areas in Chicago.

Research and design methods: In this retrospective longitudinal cohort study, 1638 newly diagnosed type 2 diabetes patients with a minimum of 6 months of follow-up were indentified. These patients were managed in an ADA-certified diabetes center caring for an underserved population in John H. Stroger Jr. Hospital of Cook County, a public healthcare system in Chicago. Demographic, clinical and laboratory data were abstracted from a detailed electronic database. The effects of contributing factors on improved A1C (defined as delta A1C ≤ -0.5% from baseline to end of follow-up) and on achieving target A1C < 7% were analyzed.

Results: Mean age 52 ± 12 years, males 53%, duration of follow up 38 ± 32 months, number of visits 8 ± 5, BMI 34 ± 8. At presentation, 10.3% had macrovascular complications and 50.5% had microvascular complications. Mean A1c at presentation was 10 ± 2.9%, and at the end of follow-up was 7.8 ± 2.2%, 69.6% of patients had improved A1C and 48.3% achieved target A1C < 7%. 91.2% were monitoring their blood glucose. Most of the patients were treated with oral medications and 40.1% used insulin, 27.6% reported missing their medications.

Improved A1C correlated with monitoring of blood glucose (OR 2.65, 95% CI 1.70 – 4.13), having higher initial HbA1c (OR 1.85, 95% CI 1.72 – 1.98), not missing medications (OR 1.66, 95% CI 1.23 – 2.25). It was inversely correlated with the use of insulin (OR 0.38, 95% CI 0.28 – 0.51) and follow up duration (OR 0.99, 95% CI 0.985 – 0.994), all P < 0.01.

Achieving diabetes control (A1c < 7%) significantly correlated with monitoring blood glucose at home (OR 2.14, 95% CI 1.31 – 3.52, P 0.02), not missing medications (OR 1.88, 95% CI 1.42 – 2.48, P < 0.01), having more visits with the provider (OR 1.04, 95% CI 1.01 – 1.08, P 0.05) and older age (OR 1.03, 95% CI 1.01 – 1.04, P < 0.01). It was inversely correlated with the use of insulin (OR 0.47, 95% CI 0.36 – 0.62, P < 0.01), initial HbA1c (OR 0.93, 95% CI 0.89 - 0.98, P < 0.01) and follow up duration (OR 0.98, 95% CI 0.97 – 0.98, P < 0.01)

Factors that were not correlated with improved A1C or A1C <7%: self-reported anxiety or depression, language (especially that we have large Spanish-speaking community), level of education, any complications at presentation, triglycerides/HDL ratio, number of oral medications, amount of insulin, exercise or BMI.

Conclusion: In newly diagnosed type 2 diabetes, achieving better glycemic control over time was mainly related to patient self-management behaviors. Utilization of insulin, as an indirect indicator of accelerated beta cell failure, was associated with worse glycemic control. Emphasis on patients’ diabetes education and empowerment appears to be a critical component in achieving better glycemic control after diagnosis of diabetes

 

Nothing to Disclose: MM, LF