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Cited by 574Diabetes Treatment and ManagementDiabetes Management and ResearchDiabetes, Cardiovascular Risks, and Lipoproteins

The Legacy Effect in Type 2 Diabetes: Impact of Early Glycemic Control on Future Complications (The Diabetes & Aging Study)

Open access
Laiteerapong, Neda, Ham, Sandra A., Gao, Yue, Moffet, Howard H., Liu, Jennifer Y., Huang, Elbert S., Karter, Andrew J.·2019·Diabetes Care
DOI 10.2337/dc17-1144PMC PMC6385699
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Abstract

OBJECTIVE: To examine for a legacy effect of early glycemic control on diabetic complications and death. RESEARCH DESIGN AND METHODS: This cohort study of managed care patients with newly diagnosed type 2 diabetes and 10 years of survival (1997–2013, average follow-up 13.0 years, N = 34,737) examined associations between HbA1c <6.5% (<48 mmol/mol), 6.5% to <7.0% (48 to <53 mmol/mol), 7.0% to <8.0% (53 to <64 mmol/mol), 8.0% to <9.0% (64 to <75 mmol/mol), or ≥9.0% (≥75 mmol/mol) for various periods of early exposure (0–1, 0–2, 0–3, 0–4, 0–5, 0–6, and 0–7 years) and incident future microvascular (end-stage renal disease, advanced eye disease, amputation) and macrovascular (stroke, heart disease/failure, vascular disease) events and death, adjusting for demographics, risk factors, comorbidities, and later HbA1c. RESULTS: Compared with HbA1c <6.5% (<48 mmol/mol) for the 0-to-1-year early exposure period, HbA1c levels ≥6.5% (≥48 mmol/mol) were associated with increased microvascular and macrovascular events (e.g., HbA1c 6.5% to <7.0% [48 to <53 mmol/mol] microvascular: hazard ratio 1.204 [95% CI 1.063–1.365]), and HbA1c levels ≥7.0% (≥53 mmol/mol) were associated with increased mortality (e.g., HbA1c 7.0% to <8.0% [53 to <64 mmol/mol]: 1.290 [1.104–1.507]). Longer periods of exposure to HbA1c levels ≥8.0% (≥64 mmol/mol) were associated with increasing microvascular event and mortality risk. CONCLUSIONS: Among patients with newly diagnosed diabetes and 10 years of survival, HbA1c levels ≥6.5% (≥48 mmol/mol) for the 1st year after diagnosis were associated with worse outcomes. Immediate, intensive treatment for newly diagnosed patients may be necessary to avoid irremediable long-term risk for diabetic complications and mortality.

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  • The A1C test is the primary tool for assessing glycemic status in both clinical practice and clinical trials, and it is strongly linked to diabetes complications.

    “The A1C test is the primary tool for assessing glycemic status in both clinical practice and clinical trials, and it is strongly linked to diabetes complications (2)(3)(4).”

    From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [2]

    The Conclusions report that higher early HbA1c levels were associated with greater risk of diabetic complications in patients newly diagnosed with type 2 diabetes who survived at least 10 years. The Exposure methods use HbA1c to assess glycemic control, and the Introduction discusses trials that used it, but neither establishes that the A1C test is the primary assessment tool in both clinical practice and clinical trials. (LLM, conf=0.84)

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  • A recent cohort study of people newly diagnosed with T2D and 10 years of survival data found that an HbA1c ≥6.5% for the 1st year after diagnosis was associated with worse outcomes (micro- and macrovascular complications), suggesting also that an early and intensive treatment for people newly diagnosed with T2D may reduce long-term risk for diabetes complications and mortality.

    “Moreover, a recent cohort study of people newly diagnosed with T2D and 10 years of survival data found that an HbA1c ≥ 6.5% (≥48 mmol/mol) for the 1st year after diagnosis was associated with worse outcomes (micro- and macrovascular complications), suggesting also that an early and intensive treatment for people newly diagnosed with T2D may reduce the long-term risk for diabetes complications and”

    From Oral glucagon-like peptide-1 receptor agonists and combinations of entero-pancreatic hormones as treatments for adults with type 2 diabetes: where are we now? (2024) · cites this paper as [94]

  • Achieving A1C targets of <7% (53 mmol/mol) has been shown to reduce microvascular complications of type 1 and type 2 diabetes when instituted early in the course of disease.

    “Therefore, achieving A1C targets of <7% (53 mmol/mol) has been shown to reduce microvascular complications of type 1 and type 2 diabetes when instituted early in the course of disease (2,48).”

    From 6. Glycemic Targets: <i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [2]

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Authors
Laiteerapong, N., Ham, S. A., Gao, Y., Moffet, H. H., Liu, J. Y., Huang, E. S., & Karter, A. J.
Affiliations
  • University of Chicago (US)
  • Kaiser Permanente (US)
Corresponding author
Laiteerapong, Neda
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2018-08-13
Volume
42
Issue
3
Pages
416-426
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc17-1144
PMC
PMC6385699
OpenAlex
W2885657542
Cited by
574
References
28
Citations by year
2026: 50 · 2025: 69 · 2024: 98 · 2023: 103 · 2022: 91 · 2021: 73 · 2020: 61 · 2019: 27 · 2018: 2
FWCI
33.59
Type
journal article
Language
en
Open access
Licence
www.diabetesjournals.org/content/license (vor, 191 d)
Locations
  • Diabetes Care (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institute of Diabetes and Digestive and Kidney Diseases
  • American Diabetes Association (1-18-JDF-037, K24-DK-105340, P30-DK-092949, P30-DK-092924, R01-DK-081796, R56-AG-051683)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
legacy effects, type 2 diabetes, glycemic control, HbA1c, microvascular complications, macrovascular complications, end-stage renal disease, diabetic eye disease, amputation, stroke, mortality, newly diagnosed diabetes, diabetes complications risk, diabetes complications
MeSH terms
Aged, Aging, Blood Glucose, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Glycated Hemoglobin, Humans, Male, Middle Aged, Risk Factors, Time Factors, United States, Cohort Studies, Comorbidity, Survival Analysis, Disease Progression, Diabetes Complications, Early Medical Intervention

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