Diabetes Progression in Untreated Patients

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Clinical predictors of disease progression and medication initiation in untreated patients with type 2 diabetes and A1C < 7%, by L.N. Pani and colleagues. Diabetes Care.Published online ahead of print on 14 December 2007

What is the problem and what is known about it so far?

Early medical treatment for type 2 diabetes may slow its progression. However, many people with early diabetes remain untreated or are treated through diet and lifestyle measures alone. Diabetes may worsen at different rates in different people, and little is known about why or at what pace worsening of the disease may occur in patients whose A1C levels (a measure of long-term blood glucose control) are still fairly low and who do not yet take diabetes medicines.

Why did researchers do this particular study?

The researchers wanted to find out what factors might predict worsening of early type 2 diabetes, as well as what factors are linked with starting diabetes medicines for those whose disease does worsen.

Who was studied?

The study included 705 adults with type 2 diabetes who had been seen for regular diabetes care at least twice during a 1-year period. The patients had initial A1C levels no higher than 7% and were taking no glucose-lowering medicines at the beginning of the year.

How was the study done?

Researchers looked at a year’s worth of patient information from the clinics’ computerized medical records to find those whose diabetes had worsened (resulting in either an A1C of 7% or higher or the need for diabetes medicine) by the end of the year studied. Researchers then analyzed which factors may have been related to their diabetes getting worse.

What did the researchers find?

More than 25 percent of the patients experienced worsening of their diabetes within 1 year. Of those, more than one-third remained untreated with medicines. Higher initial A1C levels, younger age, and weight gain were the factors most likely to be linked with worsening of diabetes. Of the patients whose diabetes did get worse, those who were younger and had higher LDL (“bad”) cholesterol levels were more likely to begin taking a diabetes medicine. Having known heart disease did not increase a patient’s chance of being started on a diabetes medicine.

What were the limitations of the study?

The study did not look at how well patients followed their lifestyle and medicine programs, both of which may have influenced their physicians’ decisions about whether to start them on a diabetes medicine. Because the study took place in academic health centers, its results may not apply to those in other types of clinics. Researchers did not learn patients’ family history of diabetes, nor did they measure exactly how long patients had had diabetes, both of which may have helped to predict worsening of their diabetes.

What are the implications of the study?

Younger patients with type 2 diabetes and those who gain weight are more likely to have worsening diabetes. Helping such patients aggressively manage their diabetes early on may be an important and cost-effective way to address the diabetes epidemic. Early diabetes management may not be aggressive enough in older patients and those who have heart disease.  

FOR MORE INFORMATION

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