Association of the glycemic background patterns and the diabetes management efficacy in poorly controlled type 2 diabetes

Abstract

Background: Inadequate glycemic control in patients with type 2 diabetes (T2DM) is a major public health problem and a significant risk factor for the progression of diabetic complications.

Aim: To evaluate the effects of intensive and supportive glycemic management strategies over a 12-month period in individuals with T2DM with glycated hemoglobin (HbA1c) ≥ 10% and varying backgrounds of glycemic control.

Methods: This prospective observational study investigated glycemic control in patients with poorly controlled T2DM over 12 months. Participants were categorized into four groups based on prior glycemic history: Newly diagnosed, previously well controlled with recent worsening, previously off-target but now worsening, and HbA1c consistently above 10%. HbA1c levels were monitored quarterly, and patients received medical, educational, and dietary support as needed. The analysis focused on the success rates of good glycemic control and the associated factors within each group.

Results: The study showed significant improvements in HbA1c levels in all participants. The most significant improvement was observed in individuals newly diagnosed with diabetes: 65% achieved an HbA1c target of ≤ 7%. The results varied between participants with different glycemic control histories, followed by decreasing success rates: 39% in participants with previously good glycemic control, 21% in participants whose glycemic control had deteriorated compared to before, and only 10% in participants with persistently poor control, with mean HbA1c levels of 6.3%, 7.7%, 8.2%, and 9.7%, respectively. After one year, 65.2% of the "newly diagnosed patients", 39.3% in the "previously controlled group", 21.9% in the "previously off-target but now worsened'" group and 10% in the "poorly controlled from the start" group had achieved HbA1c levels of 7 and below.

Conclusion: In poorly controlled diabetes, the rate at which treatment goals are achieved is associated with the glycemic background characteristics, emphasizing the need for tailored strategies. Therefore, different and comprehensive treatment approaches are needed for patients with persistent uncontrolled diabetes.

Keywords: Diabetes management; Glycated hemoglobin; Glycemic control; Patient-centered care; Type 2 diabetes mellitus; glycemic background.

Figure 1

Graphic abstract of the results. T2DM: Type 2 diabetes; HbA1c: Glycated hemoglobin.

Figure 2

Baseline and 12^th month medication usage: Group A vs group B. DPP-IV: Dipeptidyl peptidase IV; SGLT2: Sodium-glucose transport protein 2; SU/GLN: Sulfonylurea/glinides.

Figure 3

The success rates of the groups in attaining glycemic control. HbA1c: Glycated hemoglobin.