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

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.