Related Experiment Video
Updated: Jun 25, 2025
Electrochemiluminescence Assays for Human Islet Autoantibodies
Published on: March 23, 2018
Longitudinal HbA1c patterns before the first treatment of diabetes in routine clinical practice: A latent class
Sia Kromann Nicolaisen1, Saskia le Cessie2, Reimar Wernich Thomsen1
1Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark.
Insights
Four distinct patterns of hemoglobin A1c (HbA1c) levels were observed before diabetes treatment initiation. Most patients showed elevated HbA1c for months prior, suggesting delayed therapeutic intervention in diabetes care.
Area of Science:
- Endocrinology
- Diabetes Mellitus Research
- Clinical Practice
Background:
- Glycemic control is crucial in managing diabetes mellitus.
- Longitudinal HbA1c trends preceding treatment initiation are not well-characterized.
- Understanding these patterns can reveal delays in diabetes care.
Purpose of the Study:
- To investigate the heterogeneity of HbA1c trajectories before initiating diabetes treatment.
- To identify distinct patterns of glycemic control in individuals prior to glucose-lowering drug prescription.
Main Methods:
- Population-based study using routine laboratory and healthcare data.
- Latent class trajectory analysis applied to HbA1c measurements from 5 years pre-treatment.
- Analysis included 20,733 individuals initiating diabetes treatment.
Main Results:
- Four distinct longitudinal HbA1c trajectories were identified.
- The largest group (74%) had HbA1c above 48 mmol/mol nine months before treatment.
- Other groups exceeded the diagnostic threshold 1.5 years prior, with peak HbA1c levels reaching up to 137 mmol/mol.
Conclusions:
- Distinct HbA1c patterns exist before diabetes treatment initiation.
- Elevated HbA1c levels were consistently observed months before treatment, indicating therapeutic inertia.
- These findings highlight potential delays in initiating diabetes management.
Aims:
To examine the longitudinal heterogeneity of HbA1c preceding the initiation of diabetes treatment in clinical practice.
Methods:
In this population-based study, we used HbA1c from routine laboratory and healthcare databases. Latent class trajectory analysis was used to classify individuals according to their longitudinal HbA1c patterns before first glucose-lowering drug prescription irrespective of type of diabetes.
Results:
Among 21,556 individuals initiating diabetes treatment during 2017-2018, 20,733 (96 %) had HbA1c measured (median 4 measurements [IQR 2-7]) in the 5 years preceding treatment initiation. Four classes with distinct HbA1c trajectories were identified, with varying steepness of increase in HbA1c. The largest class (74 % of the individuals) had mean HbA1c above the 48 mmol/mol threshold 9 months before treatment initiation. Mean HbA1c was 52 mmol/mol (95 % CI 52-52) at treatment initiation. In the remaining three classes, mean HbA1c exceeded 48 mmol/mol almost 1.5 years before treatment initiation and reached 79 mmol/mol (95 % CI 78-80), 105 mmol/mol (95 % CI 104-106), and 137 mmol/mol (95 % CI 135-140) before treatment initiation.
Conclusion:
We identified four distinct longitudinal HbA1c patterns before initiation of diabetes treatment in clinical practice. All had mean HbA1c levels exceeding the diagnostic threshold many months before treatment initiation, indicating therapeutic inertia.
More Related Videos
Related Concept Videos
01:15Diabetes: Symptoms, Diagnosis, and Complications
01:22Diabetes Mellitus: Type 2 and Gestational
01:20Pathophysiology of Diabetes
Type 1 diabetes is characterized by autoimmune-mediated destruction of pancreatic β cells, with environmental factors potentially triggering this process in genetically susceptible individuals. Despite many not having a family history, certain genes increase susceptibility,...
01:22Diabetes Mellitus: Overview and Type I Subtype
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
01:15Diabetes: Management and Pharmacotherapy
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
01:36Carbohydrate Metabolism
Starch accounts for approximately 60% of the carbohydrates consumed by humans. Since amylase enzymes cannot function in the stomach's acidic environment, starch can only be digested in the mouth and small intestine. Simple sugars are found naturally in milk and fruits in...