The Association Between Sustained HbA1c Control and Long-Term Complications Among Individuals with Type 2 Diabetes: A Retrospective Study

The prevalence of type 2 diabetes (T2D) represents a rising burden worldwide, a disease shown to be associated with relatively large human and economic costs. Part of the reason for such high costs is that it is often accompanied by additional complications. The goal of this research is to examine the association between glycemic control and diabetes-related complications for individuals with T2D.

The Optum Clinformatics® Data Mart (CDM) database from 2007 to 2020 was used to identify adults with T2D. 3607 individuals were classified as having sustained glycemic control with an HbA1c <7% (2119 patients) or poor glycemic control with HbA1c ≥7% (1488 patients) during the 5 years following the analysis period, and diabetes-related complications were identified based upon the Diabetes Complications Severity Index. Multivariable analyses examined the association between sustained glycemic control and diagnosis of a diabetes-related complication in the post-period.

The results showed that maintaining HbA1c <7% over the 5-year post-period, compared to maintaining HbA1c ≥ 7%, was associated with reduced odds of diabetes-related complications of cardiovascular disease, (-24%; CI 0.61–0.94), metabolic disease (-63%; CI 0.22–0.60), neuropathy (-38%; CI 0.45–0.84), nephropathy (- 19% CI 0.69–0.94) and peripheral vascular disease (-48%; CI 0.33–0.83). There was no statistically significant association between sustained glycemic control HbA1c <7% and cerebrovascular disease.

As a test of sensitivity of the results, the main analyses were repeated; with stricter glycemic controls, maintaining HbA1c <6.5% or ≥6.5% throughout the entire period after 5 years. The results showed that having HbA1c <6.5% was associated with statistically significant reductions in the odds of being diagnosed with cardiovascular disease, metabolic disease, neuropathy and nephropathy. In addition, it resulted in a significant reduction in the odds of being diagnosed with cerebrovascular disease.

In conclusion, using real-world data, this study demonstrates the negative effects associated with poor glycemic control (HbA1c ≥7%); highlighting the importance of sustained glycemic control (HbA1c <7%) to reduce the odds of complications such as cardiovascular disease, neuropathy, nephropathy and cerebrovascular disease (HbA1c <6%).

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