Longitudinal trends in HbA_1c patterns and association with outcomes: A systematic review

This study aimed to review studies that identified patterns of longitudinal HbA_1c trends in patients with diabetes and to summarize factors and outcomes associated with distinct trajectory patterns.

PubMed and Web of Science were systematically searched for studies examining HbA_1c trends among patients with diabetes from database inception through September 2017. Articles were included if they met the following inclusion criteria: (a) longitudinal study of subjects with diabetes only, (b) use of serial measurements of HbA_1c , and (c) analysis of the trend of HbA_1c using group-based trajectory approaches.

Twenty studies were included, 11 on type 1 diabetes and 9 on type 2 diabetes. These studies identified 2 to 6 HbA_1c trajectory patterns. The most commonly identified patterns included stable HbA_1c around 7.0% and at levels between 8.0% and 9.9%, which usually captured the HbA_1c pattern among the majority of subjects in the study population. Unstable patterns identified included increasing HbA_1c trend, decreasing HbA_1c trend, and non-linear patterns. These patterns were associated with differential risk of disease outcomes, over and beyond single-point HbA_1c measures. Age, gender, ethnicity, diabetes duration, disease management frequency, cardiovascular risk factors, insulin treatment, family environment, and psychosocial factors were the most frequently reported factors associated with membership of specific HbA_1c pattern groups.

Common patterns of longitudinal HbA_1c trends were identified despite heterogeneity among the studies. A better understanding of what underlies these different patterns may provide opportunities to tailor therapies and care for these patients to reduce adverse outcomes.