HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) All Versions of this Article: dc07-1934v1 31/3/386    most recent Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Pani, L. N. Articles by Grant, R. W. Search for Related Content PubMed PubMed Citation Articles by Pani, L. N. Articles by Grant, R. W. Social Bookmarking                What's this?

Clinical Predictors of Disease Progression and Medication Initiation in Untreated Patients with Type 2 Diabetes and A1C < 7%.

From the Diabetes Center and General Medicine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA

ABSTRACT

Objective: Many patients with early diabetes remain untreated. Our objectives were to identify clinical predictors of: 1) Worsening glycemic control, and 2) Medical treatment initiation in response to worsening glycemic control among patients with type 2 diabetes (T2DM).

Research Design and Methods: We identified 5804 T2DM patients seen at least twice between June 2005 and June 2006 within our 12-clinic primary care network. Among 705 patients who had A1C < 7% on no glucose lowering medications at baseline, we examined predictors of diabetes progression (A1C 7% or initiation of hypoglycemic agent) over a 1-year follow-up period. Among the 200 patients in this group who progressed, we examined predictors of medical therapy initiation.

Results: In multivariate analyses, baseline A1C (p < 0.0001), younger age (p = 0.04) and weight gain (p = 0.03) were independent predictors of progression, after adjusting for race, gender and baseline HDL levels. Each decade of increasing age reduced the risk of progression by 15%. Each 1 lb of increased weight was associated with 2% increased odds of progression. Likelihood of medication initiation among progressors decreased by 40% (p = 0.02) with every decade of age and decreased by 2.3% (p = 0.02) with each 1 mg/dl decrease from baseline LDL level after adjusting for race, gender and weight change.

Conclusions: Among untreated primary care patients with T2DM and A1C < 7%, younger patients and those with weight gain were more likely to have diabetes progression and should be the focus of aggressive diabetes management.

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?