Association of the glycemic background patterns and the diabetes management efficacy in poorly controlled type 2 diabetes

doi:10.4239/wjd.v16.i1.98322

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Jan 15, 2025 (publication date) through Dec 1, 2024

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World Journal of Diabetes

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1948-9358

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Prospective Study

World J Diabetes. Jan 15, 2025; 16(1): 98322
Published online Jan 15, 2025. doi: 10.4239/wjd.v16.i1.98322

Table 1 Baseline demographic and clinical characteristics of the patients, n (%)

	Group A (1 + 2) (n = 51)	Group B (2 + 3) (n = 81)	All patients (n = 132)	P value
Age (years)	54.4 ± 10.3	56.7 ± 9.6	55.8 ± 9.8	0.068
Gender
Female	14 (27.5)	41 (50.6)	55 (41.7)	0.009^a
Male	37 (72.5)	40 (49.4)	77 (58.3)	0.009^a
Education				0.141
No literacy	2 (3.9)	12 (14.8)	14 (10.6)
Primary school	27 (52.9)	43 (53.1)	70 (53.0)
Middle school	9 (17.6)	6 (7.4)	15 (11.4)
High school	9 (17.6)	16 (19.8)	25 (18.9)
Higher education	4 (7.8)	4 (4.9)	8 (6.1)
Physical activity				0.088
Inactive	24 (47.1)	48 (59.3)	72 (54.5)
Moderately inactive	18 (35.3)	19 (23.5)	37 (28)
Moderately active	9 (17.6)	9 (11.1)	18 (13.6)
Active	0 (0)	5 (6.2)	5 (3.8)
Diabetes course
Newly diagnosed T2DM	23 (45.1)	0 (0)	23 (17.4)
Patients with previously controlled T2DM	28 (54.9)	0 (0)	28 (21.2)
T2DM patients whose HBA1c were previously not on target but now worsened	0 (0)	32 (39.5)	32 (24.2)
T2DM patients whose HbA1c were ≥ 10% for a long time	0 (0)	49 (60.5)	49 (37.2)
Weight (kg)	83 (21)	81 ± 14	81 (19)	0.350
BMI (kg/m²)	29.4 ± 3.5	29.5 ± 4.8	29.5 ± 4.3	0.821
Waist circumference (cm)	102.1 ± 12.8	101.8 ± 14.3	101.9 ± 13.7	0.917
Duration of diabetes (year)	4 (12)	10 (8)	10 (10)	0.000^a
CKD	4 (8)	4 (5)	8 (6)	0.710
Mindful eating	3.3 ± 0.6	3.4 ± 0.6	3.4 ± 0.6	0.324
BDI	7.9 ± 5.9	12 (12)	10 (9)	0.000^a
Glucose (mg/dL)	283.9 ± 75.9	238.7 ± 77.4	254.3 ± 79.4	0.007^a
LDL-C (mg/dL)	101 ± 41.9	106 (53)	100 (53)	0.989
HDL-C (mg/dL)	36 (22)	43.6 ± 11.3	42 (18)	0.048^a
Triglyceride (mg/dL)	203.7 ± 136.7	189.1 ± 27.12	195.3 ± 96.7	0.692
Total cholesterol (mg/dL)	177 (67)	188 (49)	184 (54)	0.905
C-peptide (ng/mL)	3.1 ± 1.6	2.6 ± 1.2	2.5 (1.7)	0.060
Urea (mg/dL)	27 (10)	31.6 ± 7.9	31.2 ± 9.7	0.137
Creatinine (mg/dL)	0.8 (0.2)	0.7 ± 0.2	0.8 (0.3)	0.323
HbA1c (%)	12.9 ± 2.5	11 (2.9)	11.2 (3.2)	0.054

^aP < 0.05.

Continuous variables are presented as mean ± SD for normally distributed or median (interquartile range) for non-normally distributed. Categorical variables were presented as numbers (percentages). Chronic kidney disease is defined as epidermal growth factor receptor < 60 mL/minute/1.73 m².

T2DM: Type 2 diabetes mellitus; BMI: Body mass index; CKD: Chronic kidney disease; BDI: Beck depression inventory; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol; HbA1c: Glycated hemoglobin.

Table 2 Baseline clinical outcomes for each group, mean ± SD, n (%)

	Group 1 (n = 23)	Group 2 (n = 28)	Group 3 (n = 32)	Group 4 (n = 49)	P value
Weight (kg)	84.5 ± 20.1	86 ± 16.8	80.4 ± 13.7	81.6 ± 14.9	0.447¹
BMI (kg/m²)	28.8 ± 4.3	31.1 ± 4.8	29.1 ± 5.1	30.3 ± 4.9	0.274¹
Waist circumference (cm)	98 (16)	102.1 ± 10.4	100 (11)	104.3 ± 12.3	0.540²
Glucose (mg/dL)	294.1 ± 87.8	276.1 ± 76.3	229.1 ± 72.8	257.2 ± 76.7	0.016^a^,¹
LDL-C (mg/dL)	110 ± 38.3	114.5 (77)	106.7 ± 33.3	115.9 ± 38.3	0.824²
HDL-C (mg/dL)	42.6 (13.4)	39.2 ± 12.8	43.2 ± 10.9	45.3 (12.5)	0.194²
Triglyceride (mg/dL)	237 ± 122.2	244.5 (166.3)	173 ± 126	268.8 ± 259.2	0.722²
Total cholesterol (mg/dL)	200.1 (43.2)	208.2 ± 72.8	195.4 ± 46.6	208.7 ± 43	0.593²
C-peptide (ng/mL)	2.8 ± 1.1	3.2 ± 1.6	2.8 ± 1.4	2.4 ± 1	0.068¹
HbA1c (%)	13.4 ± 1.9	11.3 (2.4)	11.5 (2.9)	11.1 (2.3)	0.007^a^,²

^aP < 0.05.

¹P calculated by one-way analysis of variance test.

²P calculated by the Kruskal-Wallis test.

BMI: Body mass index; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol; HbA1c: Glycated hemoglobin.

Table 3 Clinical outcomes after 12 months for group a and group B, mean ± SD, n (%)

	Group A (1 + 2) (n = 51)	Group B (2 + 3) (n = 81)	All patients (n = 132)	P value
Weight (kg)	84 ± 14	80 ± 14	82 ± 14	0.159
BMI (kg/m²)	30 ± 4.5	30.4 ± 5.2	30.2 ± 4.9	0.942
Waist circumference (cm)	102.5 ± 12.4	102.7 ± 14	102 (16)	0.741
Glucose (mg/dL)	133.5 (36.8)	172.9 ± 57.5	145 (77)	0.000^a
LDL-C (mg/dL)	86.1 ± 33.6	95.7 ± 36.8	91.9 ± 35.7	0.335
HDL-C (mg/dL)	46.1 ± 15.1	45 ± 9.5	45.4 ± 11.9	0.390
Triglyceride (mg/dL)	153 (123.8)	155 ± 87	155 (100)	0.566
Total cholesterol (mg/dL)	166.9 ± 39.7	173.2 ± 42.9	170.7 ± 41.5	0.382
C-peptide (ng/mL)	2.7 (2)	2.1 (1.9)	2.3 (1.8)	0.012^a
HbA1c (%)	7 (1.2)	8.5 (2)	7.8 (2.1)	0.000^a

^aP < 0.05.

BMI: Body mass index; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol; HbA1c: Glycated hemoglobin.

Table 4 Clinical outcomes after 12 months for each group, mean ± SD, n (%)

	Group 1 (n = 23)	Group 2 (n = 28)	Group 3 (n = 32)	Group 4 (n = 49)	P value
Weight (kg)	80.8 ± 14.3	86.5 ± 13.8	80.9 ± 13.5	79.8 ± 14.3	0.253¹
BMI (kg/m²)	28.3 ± 3.4	31 ± 4.9	29.3 ± 5.3	30.1 ± 4.7	0.220¹
Waist circumference (cm)	101.9 ± 14.4	103.8 ± 10.9	100.7 ± 15	103 ± 14.2	0.844¹
Glucose (mg/dL)	125 ± 32.2	154.7 ± 45.6	137.5 (59)	199 (113)	0.000^a^,²
LDL-C (mg/dL)	86.3 ± 31.2	93.1 ± 39.1	97.6 ± 36.7	95.8 ± 41.2	0.724¹
HDL-C (mg/dL)	51 ± 26	45.6 ± 13.4	44.7 ± 11	45.7 ± 14.6	0.509¹
Triglyceride (mg/dL)	158 ± 89.8	186.5 (108.5)	149 (97)	165 (105)	0.120²
Total cholesterol (mg/dL)	164 ± 30.7	180 ± 51.7	178.1 ± 44.5	170 (63)	0.528²
C-peptide (ng/mL)	2.4 (2.1)	3.3 ± 1.4	2.5 ± 1.4	2.1 (1.1)	0.081²
HbA1c (%)	6.6 ± 0.9	7.7 ± 1.3	8.4 ± 1.7	9.4 ± 2	0.000^a^,¹

^aP < 0.05.

¹P calculated by one-way analysis of variance test.

²P calculated by the Kruskal-Wallis test.

BMI: Body mass index; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol; HbA1c: Glycated hemoglobin.

Table 5 Comparison of clinical outcomes at baseline and 12 months for group A and group B

	Group A differences (n = 51)	P value	Cohen’s d effect size	Group B difference (n = 81)	P value	Cohen’s d effect size	All patients difference (n = 132)	P value	Cohen’s d effect size
Weight (kg)	-1.5	0.282²	0.1	-0.9	0.357¹	0.1	-1.0	0.064²	0.1
BMI (kg/m²)	-0.7	0.329²	0.1	0.0	0.985¹	0.0	-0.1	0.828¹	0.0
Waist circumference (cm)	2.5	0.837²	0.1	0.5	0.507²	0.0	1.5	0.527²	0.0
Glucose (mg/dL)	-144.0	0.000^a^,²	2.2	-72.5	0.000^a^,²	0.6	-113.0	0.000^a^,²	1.1
LDL-C (mg/dL)	-26.0	0.015^a^,²	0.6	-15.8	0.040^a^,¹	0.4	-16.0	0.001^a^,²	0.5
HDL-C (mg/dL)	6.0	0.000^a^,²	0.4	1.0	0.733²	0.1	2.0	0.002^a^,²	0.2
Triglyceride (mg/dL)	-38.0	0.003^a^,²	0.4	-26.0	0.000^a^,²	0.3	-33.0	0.000^a^,²	0.3
Total cholesterol (mg/dL)	-25.0	0.001^a^,²	0.6	-20.0	0.000^a^,²	0.5	-22.5	0.000^a^,²	0.5
C-peptide (ng/mL)	0.2	0.950²	0.1	-0.1	0.299²	0.1	-0.1	0.417	0.0
HbA1c (%)	-5.1	0.000^a^,²	3.2	-2.5	0.000^a^,²	1.6	-3.9	0.000^a^,²	2.1

^aP < 0.05.

Differences denote values obtained after 12 months subtracted from baseline measurements.

¹P for normally distributed data, mean differences are presented.

²P in cases of non-normal distribution, median differences are utilized.

BMI: Body mass index; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol; HbA1c: Glycated hemoglobin.

Table 6 Comparison of clinical outcomes at baseline and 12 months for each group

	Group 1 differences (n = 23)	P value	Cohen’s d effect size	Group 2 differences (n = 28)	P value	Cohen’s d effect size	Group 3 differences (n = 32)	P value	Cohen’s d effect size	Group 4 differences (n = 49)	P value	Cohen’s d effect size
Weight (kg)	-3.7	0.476¹	0.2	0.5	0.273²	0.0	0.5	0.562²	0.0	-1.8	0.120²	0.1
BMI (kg/m²)	-0.5	0.436¹	0.1	-0.1	0.862¹	0.0	0.2	0.544¹	0.0	-0.2	0.469¹	0.0
Waist circumference (cm)	2.5	0.984²	0.0	1.7	0.950¹	0.2	-1.0	0.665²	0.2	-1.3	0.662¹	0.1
Glucose (mg/dL)	-169.1	0.000^a^,¹	2.6	-121.4	0.000^a^,¹	1.9	-80.5	0.000 ^a^,²	1.1	-47.5	0.003^a^,²	0.5
LDL-C (mg/dL)	-23.7	0.029^a^,¹	0.7	-28.5	0.095¹	0.5	-9.1	0.135¹	0.3	-20.1	0.147¹	0.5
HDL-C (mg/dL)	6.0	0.026^a^,²	0.4	6.4	0.000^a^,¹	0.5	1.5	0.331¹	0.1	-2.0	0.659²	0.0
Triglyceride (mg/dL)	-79	0.000^a^,¹	0.7	-15.0	0.438²	0.2	-24.0	0.006^a^,²	0.3	-29.0	0.006^a^,²	0.4
Total cholesterol (mg/dL)	-24.	0.002^a^,²	1.0	-28.2	0.041^a^,¹	0.4	-17.3	0.011^a^,¹	0.4	-26.0	0.005^a^,²	0.6
C-peptide (ng/mL)	0.0	0.784²	0.3	0.1	0.927¹	0.1	-0.3	0.144¹	0.2	-0.1	0.692²	0.0
HbA1c (%)	-6.8	0.000^a^,¹	4.5	-3.8	0.000 ^a^,²	2.6	-3.6	0.000^a^,²	2.2	-1.7	0.000^a^,²	1.3

^aP < 0.05.

Differences denote values obtained after 12 months subtracted from baseline measurements.

¹P for normally distributed data, mean differences are presented.

²P in cases of non-normal distribution, median differences are utilized.

BMI: Body mass index; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol; HbA1c: Glycated hemoglobin.

Table 7 Demographic and clinical characteristics by glycated hemoglobin levels (< 7% vs ≥ 7%) at 12 months, mean ± SD, n (%)

	HbA1c ≤ 7% (n = 38)	HbA1c > 7% (n = 94)	P value
Age (years)	54.2 ± 10.2	55.8 ± 10.5	0.326
Gender			0.135
Female	12 (32)	43 (46)
Male	26 (68)	51 (54)
Education
No literacy	3 (7.9)	11 (12)	0.709
Primary school	18 (47)	52 (55)
Middle school	6 (16)	9 (9.6)
High school	8 (21)	17 (18)
Higher education	3 (7.9)	5 (5.3)
Physical activity
Inactive	20 (56)	43 (49)	0.554
Moderately inactive	8 (22)	29 (33)
Moderately active	7 (19)	11 (13)
Active	1 (2.8)	4 (4.6)
Diabetes course
Newly diagnosed T2DM	15 (39)	8 (8.5)	0.000^a
Patients with previously controlled T2DM	11 (29)	17 (18)
T2DM patients whose HBA1c were previously not on target but now worsened	7 (18)	25 (27)
T2DM patients whose HbA1c were ≥ 10% for a long time	5 (13)	44 (47)
Weight (kg)	83.9 ± 12.8	80.7 ± 14.5	0.215
BMI (kg/m²)	29.7 ± 3.8	29.8 ± 5.1	0.848
Waist circumference (cm)	102.8 ± 12.6	102.3 ± 14.2	0.787
Duration of diabetes (year)	5.4 ± 5.9	10.7 ± 6.9	0.000^a
Mindful eating	3.3 ± 0.6	3.4 ± 0.5	0.320
BDI	8.6 ± 5.5	12.6 ± 8.5	0.022^a
Glucose (mg/dL)	116.9 ± 20.8	195.5 ± 85.7	0.000^a
LDL-C (mg/dL)	82.1 ± 33.3	98.9 ± 38.6	0.074
HDL-C (mg/dL)	45.3 ± 22.0	46.8 ± 13.2	0.062
Triglyceride (mg/dL)	169.5 ± 92.9	198.0 ± 144.2	0.470
Total cholesterol (mg/dL)	159.4 ± 33.7	184.6 ± 50.6	0.029^a
C-peptide (ng/mL)	3.3 ± 1.6	2.5 ± 1.2	0.006^a
HbA1c (%)	6.4 ± 0.5	9.1 ± 1.7	0.000^a

^aP < 0.05.

T2DM: Type 2 diabetes mellitus; BMI: Body mass index; BDI: Beck depression inventory; LDL-C: Low-density lipoprotein cholesterol; HDL-C: High-density lipoprotein cholesterol; HbA1c: Glycated hemoglobin.

Table 8 Medication utilization after 12 months: Group A vs group B, n (%)

Medication	Usage	Group A	Group B	All patients	P value
MTF	Yes	40 (78.4)	64 (79)	104 (78.8)	0.937
MTF	No	11 (21.6)	17 (21)	28 (21.2)	0.937
DPP-IV	Yes	27 (52.9)	63 (77.8)	90 (68.2)	0.003^a
DPP-IV	No	24 (47.1)	18 (22.2)	42 (31.8)	0.003^a
SGLT2	Yes	37 (72.5)	64 (79)	101 (76.5)	0.394
SGLT2	No	14 (27.5)	17 (21)	31 (23.5)	0.394
Pioglitazone	Yes	19 (37.3)	33 (40.7)	52 (39.4)	0.690
Pioglitazone	No	32 (62.7)	48 (59.3)	80 (60.6)	0.690
Basal insulin	Yes	4 (7.8)	33 (40.7)	37 (28)	0.000^a
Basal insulin	No	47 (92.2)	48 (59.3)	95 (72)	0.000^a
Basal-bolus insulin	Yes	4 (7.8)	15 (18.5)	19 (14.4)	0.089
Basal-bolus insulin	No	47 (92.2)	66 (81.5)	113 (85.6)	0.089
Mixed insulin	Yes	2 (3.9)	12 (14.8)	14 (10.6)	0.048^a
Mixed insulin	No	49 (96.1)	69 (85.2)	118 (89.4)	0.048^a

^aP < 0.05.

MTF: Metformin; DPP-IV: Dipeptidyl peptidase IV inhibitors; SGLT2: Sodium-glucose transport protein 2 inhibitors.

Table 9 Medication utilization after 12 months: Glycated hemoglobin ≤ 7% vs glycated hemoglobin > 7%, n (%)

Medication	Usage	HbA1c ≤ 7%	HbA1c > 7%	P value
MTF	Yes	34 (89.5)	70 (74.5)	0.046^a
MTF	No	4 (10.5)	24 (25.5)	0.046^a
DPP-IV	Yes	24 (63.2)	66 (70.2)	0.431
DPP-IV	No	14 (36.8)	28 (29.8)	0.431
SGLT2	Yes	29 (76.3)	72 (76.6)	0.973
SGLT2	No	9 (23.7)	22 (23.4)	0.973
Pioglitazone	Yes	16 (42.1)	36 (38.3)	0.685
Pioglitazone	No	22 (57.9)	58 (61.7)	0.685
Basal insulin	Yes	4 (10.5)	33 (35.1)	0.004^a
Basal insulin	No	34 (89.5)	61 (64.9)	0.004^a
Basal-bolus insulin	Yes	1 (2.6)	18 (19.1)	0.014^a
Basal-bolus insulin	No	37 (97.4)	76 (80.9)	0.014^a
Mixed insulin	Yes	0 (0)	14 (14.9)	0.012^a
Mixed insulin	No	38 (100)	80 (85.1)	0.012^a

^aP < 0.05.

MTF: Metformin; DPP-IV: Dipeptidyl peptidase IV inhibitors; SGLT2: Sodium-glucose transport protein 2 inhibitors.

Citation: 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
URL: https://www.wjgnet.com/1948-9358/full/v16/i1/98322.htm
DOI: https://dx.doi.org/10.4239/wjd.v16.i1.98322