Early Glycosylated Hemoglobin Target Achievement Predicts Clinical Outcomes in Patients with Newly Diagnosed Type 2 Diabetes Mellitus

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Diabetes Metab J. 2021;45(3):337-338
Publication date (electronic) : 2021 May 25
doi : https://doi.org/10.4093/dmj.2021.0078
Division of Endocrinology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
Corresponding author: Jae Hyoung Cho https://orcid.org/0000-0003-2235-8874 Division of Endocrinology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea E-mail: drhopper@catholic.ac.kr

Type 2 diabetes mellitus (T2DM) is a complex group of disorders sharing the common characteristic of hyperglycemia. Persistent hyperglycemia increases the risk of micro- and macrovascular complications as well as mortality in patients with T2DM [1-4]. Previous studies provided evidence that longterm durable glycemic control can decrease the incidence of diabetic complications [5]. Although previous studies have suggested the potential benefit of early intensive glucose-lowering therapy, most of the current practice guidelines recommend serial escalation of diabetic medications in patients with newly diagnosed diabetes unless those patients are severely hyperglycemic [6,7]. The optimal duration to target glycosylated hemoglobin (HbA1c) achievement and its potential benefits in a clinical setting are poorly understood.

In this issue, Kim et al. [8] demonstrate that early HbA1c target achievement predicts clinical outcomes in patients with newly diagnosed T2DM. In this observational study, authors classified newly diagnosed diabetic patients into three groups according to the time needed to achieve target HbA1c (<3, 3 to 6, and ≥6 months) and compared composite complications, microvascular complications (retinopathy, nephropathy, and neuropathy), macrovascular complications (ischemic heart disease, ischemic stroke, and peripheral artery disease) and long-term glycemic durability for 6 years. Interestingly, longer time to achieve target HbA1c was associated with an increased risk of composite complications as well as microvascular and macrovascular complications. Moreover, patients who achieved target HbA1c early after diagnosis were more likely to maintain durable glycemic control than those who took longer to achieve target HbA1c.

This article suggests two messages. First, achieving target HbA1c early is important for long-term outcomes in newly diagnosed T2DM patients. This finding encourages clinicians to put more effort into achieving target HbA1c when their patients are initially diagnosed with T2DM. Second, this research suggests that there are subgroups of newly diagnosed T2DM patients who have more difficulty achieving target HbA1c than others. As this was an observational study, all subjects underwent standard care for diabetes. The difference in the time needed to achieve target HbA1c might have been due to different characteristics or pathophysiology of the disease. Interestingly, fasting C-peptide level was lower in the subpopulation of patients who took longer to reach target HbA1c. A similar subgroup of patients with newly diagnosed T2DM were proposed in a large-scale cohort study in Sweden and Finland [9]. This subgroup was severely insulin deficient without glutamic acid decarboxylase auto-antibodies, had difficulty achieving durable HbA1c control, and were at high risk of developing micro- and macrovascular complications [8,9]. Careful characterization and potential benefit of tailored management in this subpopulation should be studied in future research. Overall, this study highlights the clinical importance of early target HbA1c achievement and suggests that some newly diagnosed T2DM patients may require more intensive therapy.



No potential conflict of interest relevant to this article was reported.


1. Gu K, Cowie CC, Harris MI. Diabetes and decline in heart disease mortality in US adults. JAMA 1999;281:1291–7.
2. Fabre J, Balant LP, Dayer PG, Fox HM, Vernet AT. The kidney in maturity onset diabetes mellitus: a clinical study of 510 patients. Kidney Int 1982;21:730–8.
3. Adler AI, Boyko EJ, Ahroni JH, Stensel V, Forsberg RC, Smith DG. Risk factors for diabetic peripheral sensory neuropathy. Results of the Seattle Prospective Diabetic Foot Study. Diabetes Care 1997;20:1162–7.
4. Klein R, Klein BE, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Arch Ophthalmol 1984;102:527–32.
5. Gaede P, Lund-Andersen H, Parving HH, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med 2008;358:580–91.
6. Weng J, Li Y, Xu W, Shi L, Zhang Q, Zhu D, et al. Effect of intensive insulin therapy on beta-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes: a multicentre randomised parallel-group trial. Lancet 2008;371:1753–60.
7. Abdul-Ghani M, Puckett C, Adams J, Khattab A, Baskoy G, Cersosimo E, et al. Durability of triple combination therapy versus stepwise addition therapy in patients with new-onset T2DM: 3-year follow-up of EDICT. Diabetes Care 2021;44:433–9.
8. Kim KJ, Choi J, Bae JH, Kim KJ, Yoo HJ, Seo JA, et al. Time to reach target glycosylated hemoglobin is associated with longterm durable glycemic control and risk of diabetic complications in patients with newly diagnosed type 2 diabetes mellitus: a 6-year observational study. Diabetes Metab J 2021;45:368–78.
9. Ahlqvist E, Storm P, Karajamaki A, Martinell M, Dorkhan M, Carlsson A, et al. Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables. Lancet Diabetes Endocrinol 2018;6:361–9.

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