Erbakan AN, Arslan Bahadır M, Kaya FN, Güleç B, Vural Keskinler M, Aktemur Çelik Ü, Faydalıel Ö, Mesçi B, Oğuz A. Association of the glycemic background patterns and the diabetes management efficacy in poorly controlled type 2 diabetes. World J Diabetes 2025; 16(1): 98322 [DOI: 10.4239/wjd.v16.i1.98322]
Corresponding Author of This Article
Ayşe N Erbakan, MD, PhD, Researcher, Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Eğitim mah, Kadıköy, Istanbul 34722, Türkiye. 17330803003@ismu.edu.tr
Research Domain of This Article
Endocrinology & Metabolism
Article-Type of This Article
Prospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Diabetes. Jan 15, 2025; 16(1): 98322 Published online Jan 15, 2025. doi: 10.4239/wjd.v16.i1.98322
Association of the glycemic background patterns and the diabetes management efficacy in poorly controlled type 2 diabetes
Ayşe N Erbakan, Müzeyyen Arslan Bahadır, Fatoş N Kaya, Büşra Güleç, Miraç Vural Keskinler, Ümmügülsüm Aktemur Çelik, Özge Faydalıel, Banu Mesçi, Aytekin Oğuz
Ayşe N Erbakan, Müzeyyen Arslan Bahadır, Fatoş N Kaya, Büşra Güleç, Miraç Vural Keskinler, Özge Faydalıel, Banu Mesçi, Aytekin Oğuz, Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul 34722, Türkiye
Ümmügülsüm Aktemur Çelik, Department of Family Medicine, Istanbul Medeniyet University, Istanbul 34722, Türkiye
Author contributions: Erbakan AN and Oğuz A designed the study; Erbakan AN, Arslan Bahadır M, Kaya FN, Güleç B, Vural Keskinler M, Faydalıel Ö, Aktemur Çelik Ü and Mesçi B conducted the study; Erbakan AN, Arslan Bahadır M, Vural Keskinler M, and Mesçi B provided clinical advice; and Erbakan AN and Kaya FN supervised the study; Erbakan AN and Oğuz A wrote the paper.
Institutional review board statement: The protocol was approved by the Ethics Committee of the Istanbul Medeniyet University Goztepe Research and Training Hospital, (approval number 2021/0413).
Clinical trial registration statement: This study is registered at ClinTrials.gov. The registration identification number is NCT06385899.
Informed consent statement: All eligible patients were invited to participate in the study, and those who agreed were given a written informed consent.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at erbakan553@hotmail.com.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ayşe N Erbakan, MD, PhD, Researcher, Department of Internal Medicine, Prof Dr Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Eğitim mah, Kadıköy, Istanbul 34722, Türkiye. 17330803003@ismu.edu.tr
Received: June 26, 2024 Revised: August 26, 2024 Accepted: October 30, 2024 Published online: January 15, 2025 Processing time: 156 Days and 14.1 Hours
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.
Core Tip: Twelve months of enhanced monitoring and facilitated access to hospital visits in patients with poorly controlled type 2 diabetes resulted in substantial improvements in glycemic control. However, the glycemic background of patients had a significant impact on the success of glycemic control. The group with newly diagnosed diabetes showed the most favorable results (mean glycated hemoglobin at 12 months, 6.3%), whereas the group with persistently poorly controlled diabetes exhibited the worst results (mean glycated hemoglobin at 12 months, 9.7%), suggesting that new approaches are needed to improve treatment efficacy.
