Changes in HbA1c level over a 12-week follow-up in patients with type 2 diabetes following a medication change.

<h4>Background</h4>Current guidance about the interval needed before retesting HbA1c when monitoring for glycaemic control is based on expert opinion rather than well-powered studies. The aim of our work was to explore how fast HbA1c changes after a change in glucose-lowering medication....

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Autores principales:	Jennifer A Hirst, Richard J Stevens, Andrew J Farmer
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/e80ae72643ca472eb7f1608c3e160342
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spelling	oai:doaj.org-article:e80ae72643ca472eb7f1608c3e1603422021-11-18T08:26:25ZChanges in HbA1c level over a 12-week follow-up in patients with type 2 diabetes following a medication change.1932-620310.1371/journal.pone.0092458https://doaj.org/article/e80ae72643ca472eb7f1608c3e1603422014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24667212/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Current guidance about the interval needed before retesting HbA1c when monitoring for glycaemic control is based on expert opinion rather than well-powered studies. The aim of our work was to explore how fast HbA1c changes after a change in glucose-lowering medication. This has implications for whether routine HbA1c testing intervals before 12 weeks could inform diabetes medication adjustments.<h4>Methods</h4>This 12-week cohort study recruited patients from 18 general practices in the United Kingdom with non-insulin treated diabetes who were initiating or changing dose of oral glucose-lowering medication. HbA1c was measured at baseline and 2, 4, 8 and 12 weeks after recruitment. HbA1c levels at earlier time intervals were correlated with 12-week HbA1c. A ROC curve analysis was used to identify the 8-week threshold above which medication adjustment may be clinically appropriate.<h4>Results</h4>Ninety-three patients were recruited to the study. Seventy-nine patients with no change in medication and full 12-week follow-up had the following baseline characteristics: mean ± standard deviation age of 61.3 ± 10.8 years, 34% were female and diabetes duration of 6.0 ± 4.3 years. Mean HbA1c at baseline, 2, 4, 8 and 12 weeks was 8.7 ± 1.5%, (72.0 ± 16.8 mmol/mol) 8.6 ± 1.6% (70.7 ± 17.0 mmol/mol), 8.4 ± 1.5% (68.7 ± 15.9 mmol/mol), 8.2 ± 1.4% (66.3 ± 15.8 mmol/mol) and 8.1 ± 1.4% (64.8 ± 15.7 mmol/mol) respectively. At the end of the study 61% of patients had sub-optimal glycaemic control (HbA1c>7.5% or 59 mmol/mol). The 8-week change correlated significantly with the 12-week change in HbA1c and an HbA1c above 8.2% (66 mmol/mol) at 8 weeks correctly classified all 28 patients who had not achieved glycaemic control by 12 weeks.<h4>Conclusions/interpretation</h4>This is the first study designed with sufficient power to examine short-term changes in HbA1c. The 12-week change in HbA1c can be predicted 8 weeks after a medication change. Many participants who had not achieved glycaemic control after 12 weeks may have benefitted from an earlier review of their HbA1c and medication.Jennifer A HirstRichard J StevensAndrew J FarmerPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 3, p e92458 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Jennifer A Hirst Richard J Stevens Andrew J Farmer Changes in HbA1c level over a 12-week follow-up in patients with type 2 diabetes following a medication change.
description	<h4>Background</h4>Current guidance about the interval needed before retesting HbA1c when monitoring for glycaemic control is based on expert opinion rather than well-powered studies. The aim of our work was to explore how fast HbA1c changes after a change in glucose-lowering medication. This has implications for whether routine HbA1c testing intervals before 12 weeks could inform diabetes medication adjustments.<h4>Methods</h4>This 12-week cohort study recruited patients from 18 general practices in the United Kingdom with non-insulin treated diabetes who were initiating or changing dose of oral glucose-lowering medication. HbA1c was measured at baseline and 2, 4, 8 and 12 weeks after recruitment. HbA1c levels at earlier time intervals were correlated with 12-week HbA1c. A ROC curve analysis was used to identify the 8-week threshold above which medication adjustment may be clinically appropriate.<h4>Results</h4>Ninety-three patients were recruited to the study. Seventy-nine patients with no change in medication and full 12-week follow-up had the following baseline characteristics: mean ± standard deviation age of 61.3 ± 10.8 years, 34% were female and diabetes duration of 6.0 ± 4.3 years. Mean HbA1c at baseline, 2, 4, 8 and 12 weeks was 8.7 ± 1.5%, (72.0 ± 16.8 mmol/mol) 8.6 ± 1.6% (70.7 ± 17.0 mmol/mol), 8.4 ± 1.5% (68.7 ± 15.9 mmol/mol), 8.2 ± 1.4% (66.3 ± 15.8 mmol/mol) and 8.1 ± 1.4% (64.8 ± 15.7 mmol/mol) respectively. At the end of the study 61% of patients had sub-optimal glycaemic control (HbA1c>7.5% or 59 mmol/mol). The 8-week change correlated significantly with the 12-week change in HbA1c and an HbA1c above 8.2% (66 mmol/mol) at 8 weeks correctly classified all 28 patients who had not achieved glycaemic control by 12 weeks.<h4>Conclusions/interpretation</h4>This is the first study designed with sufficient power to examine short-term changes in HbA1c. The 12-week change in HbA1c can be predicted 8 weeks after a medication change. Many participants who had not achieved glycaemic control after 12 weeks may have benefitted from an earlier review of their HbA1c and medication.
format	article
author	Jennifer A Hirst Richard J Stevens Andrew J Farmer
author_facet	Jennifer A Hirst Richard J Stevens Andrew J Farmer
author_sort	Jennifer A Hirst
title	Changes in HbA1c level over a 12-week follow-up in patients with type 2 diabetes following a medication change.
title_short	Changes in HbA1c level over a 12-week follow-up in patients with type 2 diabetes following a medication change.
title_full	Changes in HbA1c level over a 12-week follow-up in patients with type 2 diabetes following a medication change.
title_fullStr	Changes in HbA1c level over a 12-week follow-up in patients with type 2 diabetes following a medication change.
title_full_unstemmed	Changes in HbA1c level over a 12-week follow-up in patients with type 2 diabetes following a medication change.
title_sort	changes in hba1c level over a 12-week follow-up in patients with type 2 diabetes following a medication change.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/e80ae72643ca472eb7f1608c3e160342
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Changes in HbA1c level over a 12-week follow-up in patients with type 2 diabetes following a medication change.

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