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Cited by 79Diabetes Management and ResearchDiabetes Treatment and ManagementDiabetes Management and Education

Glycemic control in diabetes mellitus: have changes in therapy made a difference?

Nathan, David M., McKitrick, Charles, Larkin, Mary, Schaffran, Robin, Singer, Daniel E.·1996·The American Journal of Medicine
DOI 10.1016/s0002-9343(97)89453-3
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Abstract

Purpose New methods of measuring and controlling glycemia in diabetes mellitus have been developed and implemented in the past 10 years. We examined whether glycemia, as measured by glycosylated hemoglobin, changed in outpatient insulin-dependent diabetes mellitus (IDDM) and noninsulin-dependent diabetes mellitus (NIDDM) populations between 1985 and 1993 and whether contemporaneous changes in therapy could account for observed changes in glycemia.Patients and methods Outpatients were selected based on having glycated hemoglobin (HbA1c) measured in the Massachusetts General Hospital laboratory during March 1985 (IDDM n = 94 and NIDDM n = 137) or during March 1993 (IDDM n = 89 and NIDDM n = 118). Chart reviews established demographic and clinical characteristics, including frequency of blood glucose self-monitoring, insulin injections, office visits, and HbA1c measurements during the year prior to the HbA1c result.Results Mean HbA1c level was significantly lower in the 1993 IDDM cohort compared with the 1985 cohort (8.77% +/- 1.7% versus 9.47% +/- 2.1%, P = 0.014). In the NIDDM cohorts, the difference in mean HbA1c did not achieve statistical significance (8.35% +/- 1.6% in 1993 versus 8.75% +/- 2.1% in 1985, P = 0.09); however, when adjusted for differences in NIDDM duration, HbA1c in the 1993 cohort was significantly lower than that in the 1985 cohort. The largest decrease in HbA1c in NIDDM was in patients treated with insulin (9.53% +/- 2.0% versus 8.54% +/- 1.5% in 1985 and 1993, respectively, P = 0.004). Multiple linear regression analyses demonstrated that increased frequency of self-monitoring and of insulin injections were associated with lower HbA1c in IDDM.Conclusions The level of average glycemia has decreased in IDDM patients over the past 8 years, attributable, at least in part, to an increased frequency of monitoring and of insulin injections. Glycemia decreased in NIDDM, especially in the subset of patients treated with insulin. This temporal shift in glycemic control should have a salutary effect on the development of long-term microvascular and neurologic complications.

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Authors
Nathan, D. M., McKitrick, C., Larkin, M., Schaffran, R., & Singer, D. E.
Affiliations
  • Massachusetts General Hospital (US)
  • Harvard University (US)
Corresponding author
Nathan, David M.
ORCID
Venue
The American Journal of Medicine
Publisher
Elsevier BV
Published
1996-02
Volume
100
Issue
2
Pages
157-163
ISSN
0002-9343 (ISSN-L)
DOI
10.1016/s0002-9343(97)89453-3
OpenAlex
W2093217653
Cited by
79
References
24
Citations by year
2022: 1 · 2021: 1 · 2018: 2 · 2017: 1 · 2016: 4 · 2015: 2 · 2014: 2 · 2013: 2 · 2012: 4
FWCI
1.34
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • The American Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Center for Research Resources (RR01166)
  • NIH Clinical Center
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
glycemic control, diabetes mellitus, HbA1c, type 1 diabetes, type 2 diabetes, self-monitoring of blood glucose, insulin therapy, insulin injection, outpatient diabetes management, glycated hemoglobin measurement, diabetes duration, diabetes mortality, diabetes-related hospitalization
MeSH terms
Adult, Diabetes Mellitus, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Hyperglycemia, Male, Middle Aged, Diabetes Complications

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