Background: Youth with type 2 diabetes develop early treatment failure to metformin and diabetes-related comorbidities.
Objective: To identify risk factors for glycemic failure in youth with type 2 diabetes.
Methods: Anthropomorphic measures, medication records, and laboratory studies were collected from patients attending a dedicated type 2 diabetes clinic. Repeat measures of HbA1c were averaged to prevent errors from unbalanced data points. Latent profile analysis (LPA) was performed to model longitudinal trajectory of HbA1c over 5 years.
Results: The registry includes 226 patients, of which 80% are Latinx. Analysis of the glycemic outcomes showed that the odds ratio (OR) for uncontrolled diabetes 5 years after diagnosis (HbA1c>8%) is proportional to baseline HbA1c, with OR of 2.41 when diagnostic HbA1c >8.5% (sensitivity 68%, specificity 54%, P=0.015). LPA modeling identified three HbA1c profiles, all demonstrating some improvement in HbA1c at 4-6 months: (A) HbA1c <8% throughout the 5 years, (B) persistent elevation of HbA1c >9%, and (C) mean HbA1c of 12% at diagnosis, rapid decline to 6.4% by 4-6 months, but rose to 11% by 18 months. At diagnosis, group A had lower HbA1c and higher fasting c-peptide levels than B and C, suggesting that baseline beta-cell function is a dominant variable in long-term glycemic control. Our analysis of medication regimen showed that amongst patients treated with metformin, the addition of multiple daily injections (MDI) did not improve HbA1c compared to those on basal insulin. Finally, weight loss correlated with improved HbA1c outcome in patients on metformin monotherapy, but not in patients prescribed insulin.
Conclusion: Patients with baseline HbA1c >8.5% are at high risk for glycemic failure, irrespective of short-term improvement in HbA1c. Additional studies are needed to decipher if medication omission accounts for the comparable HbA1c outcome between patients on MDI and basal insulin.
L. Chao: None. M. Yeh: None. J. Raymond: None. J. Ryoo: None. N.T. Chang: None.
Good Hope Foundation; Saban Research Institute