Dataset Information

Factors associated with potential over- and undertreatment of hyperglycaemia and annual measurement of HbA_1c in type 2 diabetes in norwegian general practice.

ABSTRACT:

Aims

To identify individual and general practitioner (GP) characteristics associated with potential over- and undertreatment of hyperglycaemia in type 2 diabetes and with HbA_1c not being measured.

Methods

A cross-sectional study that included 10233 individuals with type 2 diabetes attending 282 GPs. Individuals with an HbA_1c measurement during the last 15 months were categorized as potentially overtreated if they were prescribed a sulphonylurea and/or insulin when the HbA_1c was less than 53 mmol/mol (7%) when aged over 75 years or less than 48 mmol/mol (6.5%) when aged between 65 and 75 years. Potential undertreatment was defined as age less than 60 years and HbA_1c > 64 mmol/mol (8.0%) or HbA_1c > 69 mmol/mol (8.5%) and treated with lifestyle modification and/or monotherapy. We used multilevel binary and multinominal logistic regression models to examine associations.

Results

Overall, 4.1% were potentially overtreated, 7.8% were potentially undertreated and 11% did not have HbA_1c measured. Characteristics associated with potential overtreatment were as follows: long diabetes duration, prescribed antihypertensive medication, cardiovascular disease and renal failure. Potential undertreatment was associated with male gender, non-western origin and low educational level. Characteristics associated with not having an HbA_1c measurement performed were male gender, age < 50 years and cardiovascular diseases. GP specialist status and GPs' use of a Noklus diabetes application reduced the risk of not having an HbA_1c measurement performed.

Conclusion

Potential overtreatment in elderly individuals with type 2 diabetes was relatively low. Nevertheless, appropriate de-intensification or intensification of treatment and regular HbA_1c measurement in identified subgroups is warranted.

SUBMITTER: Tran AT

PROVIDER: S-EPMC8359382 | biostudies-literature | 2021 Aug

REPOSITORIES: biostudies-literature

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Publications

Factors associated with potential over- and undertreatment of hyperglycaemia and annual measurement of HbA<sub>1c</sub> in type 2 diabetes in norwegian general practice.

Tran Anh T AT Berg Tore J TJ Mdala Ibrahimu I Gjelsvik Bjørn B Cooper John G JG Sandberg Sverre S Claudi Tor T Jenum Anne K AK

Diabetic medicine : a journal of the British Diabetic Association 20210107 8

<h4>Aims</h4>To identify individual and general practitioner (GP) characteristics associated with potential over- and undertreatment of hyperglycaemia in type 2 diabetes and with HbA<sub>1c</sub> not being measured.<h4>Methods</h4>A cross-sectional study that included 10233 individuals with type 2 diabetes attending 282 GPs. Individuals with an HbA<sub>1c</sub> measurement during the last 15 months were categorized as potentially overtreated if they were prescribed a sulphonylurea and/or insulin ...[more]

PMID: 33354827

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Project description:Aims/hypothesisThe aim of the study was to evaluate longitudinal associations between HbA1c levels, diabetes status and subsequent cognitive decline over a 10 year follow-up period.MethodsData from wave 2 (2004-2005) to wave 7 (2014-2015) of the English Longitudinal Study of Ageing (ELSA) were analysed. Cognitive function was assessed at baseline (wave 2) and reassessed every 2 years at waves 3-7. Linear mixed models were used to evaluate longitudinal associations.ResultsThe study comprised 5189 participants (55.1% women, mean age 65.6 ± 9.4 years) with baseline HbA1c levels ranging from 15.9 to 126.3 mmol/mol (3.6-13.7%). The mean follow-up duration was 8.1 ± 2.8 years and the mean number of cognitive assessments was 4.9 ± 1.5. A 1 mmol/mol increment in HbA1c was significantly associated with an increased rate of decline in global cognitive z scores (-0.0009 SD/year, 95% CI -0.0014, -0.0003), memory z scores (-0.0005 SD/year, 95% CI -0.0009, -0.0001) and executive function z scores (-0.0008 SD/year, 95% CI -0.0013, -0.0004) after adjustment for baseline age, sex, total cholesterol, HDL-cholesterol, triacylglycerol, high-sensitivity C-reactive protein, BMI, education, marital status, depressive symptoms, current smoking, alcohol consumption, hypertension, CHD, stroke, chronic lung disease and cancer. Compared with participants with normoglycaemia, the multivariable-adjusted rate of global cognitive decline associated with prediabetes and diabetes was increased by -0.012 SD/year (95% CI -0.022, -0.002) and -0.031 SD/year (95% CI -0.046, -0.015), respectively (p for trend <0.001). Similarly, memory, executive function and orientation z scores showed an increased rate of cognitive decline with diabetes.Conclusions/interpretationSignificant longitudinal associations between HbA1c levels, diabetes status and long-term cognitive decline were observed in this study. Future studies are required to determine the effects of maintaining optimal glucose control on the rate of cognitive decline in people with diabetes.

Project description:IntroductionObesity is associated with compromised glucose metabolism. Hence, it is of interest to investigate if the lifestyle interventions used in the LIBRA-cohort, which aimed at not only weight loss, but also patient well-being, could also help obese patients improve glucose metabolism by evidence of reduced HbA1c. The aim of the study was to retrospectively investigate if patients who were referred to a lifestyle intervention for obesity, were able to alter HbA1c.Research design and methodsPatients with a BMI≥30 undergoing a 6-month lifestyle intervention, who also completed physical and mental health surveys and whose baseline and 6-month blood samples were available, were included in the analysis. For changes in HbA1c and body weight a clinically relevant change of 5≥mmom/mol and 5%≥, respectively, was chosen. Participants were divided into groups according to their baseline HbA1c level: "Diabetes": HbA1c of ≥6.5% (≥48 mmol/mol), "Prediabetes": HbA1c of 5.7% to 6.4% (39-47.99 mmol/mol) or "Normal" HbA1c <5.7% (<39 mmol/mol).Results180 patients met the stated inclusion criteria and these patients were divided into groups (median age (25th;75th quartile): Diabetes: n=47, age 54 (43;60), 51% women, Prediabetes: n=68, age 60 (50;66), 71% women and Normal: n=65, median age 61 (50;66), 85% women. Significant reductions were found in all three groups and specifically in the diabetes group HbA1c was reduced (mean [95%CI]) -5[-8;-2] mmol/mol from baseline to the end of the intervention. Furthermore, 35% of patients with prediabetes normalized their HbA1c (<39) and 30% patients with diabetes reduced their HbA1c <48. All groups had clinically relevant (≥5%) reductions in body weight (p<0.01). There was an association between body weight reduction and HbA1c reduction in the diabetes group (p<0.01). All groups reported improvements in physical health (p<0.01).ConclusionIn this retrospective cohort study, all patients achieved clinically relevant weight loss after participation in the lifestyle intervention and obese patients with diabetes achieved clinically relevant reductions in HbA1c after 6-months. More than 1/3 of patients with prediabetes normalized their HbA1c.

Dataset Information

Factors associated with potential over- and undertreatment of hyperglycaemia and annual measurement of HbA_1c in type 2 diabetes in norwegian general practice.

Aims

Methods

Results

Conclusion

Publications

Factors associated with potential over- and undertreatment of hyperglycaemia and annual measurement of HbA<sub>1c</sub> in type 2 diabetes in norwegian general practice.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Dataset Information

Factors associated with potential over- and undertreatment of hyperglycaemia and annual measurement of HbA1c in type 2 diabetes in norwegian general practice.

Aims

Methods

Results

Conclusion

Publications

Factors associated with potential over- and undertreatment of hyperglycaemia and annual measurement of HbA<sub>1c</sub> in type 2 diabetes in norwegian general practice.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets

Factors associated with potential over- and undertreatment of hyperglycaemia and annual measurement of HbA_1c in type 2 diabetes in norwegian general practice.