Treat-to- target HbA1c and lipid profile to prolong beta-cell mass/function and optimize treatment-goal attainment

GAGLIARDINO, JUAN J.; ELGART, JORGE; FORTI, LUJÁN; SILVINA, GUAITA MARÍA; CHANTELOT, JEAN M.

DIABETES/METABOLISM RESEARCH AND REVIEWS.

JOHN WILEY & SONS LTD

Lugar: LOndres; Año: 2019

1520-7552

AIM: To evaluate the relation between different serum lipid fractions and other known barriers to attain the HbA1c ≤ 7.0% (53 mmol/mol) target.METHODS:Data on 2719 patients with type 2 diabetes were collected from the five waves of the International Diabetes Mellitus Practice Study implemented in Argentina (2006 to 2012) including: demographic/socioeconomic profile, clinical, metabolic (HbA1c and serum lipids) data, and treatment type; also, percentage of treatment goal attainment. Descriptive statistical analyses included ANOVA, Chi2 test, and Fisher´s exact test; univariate and multivariate logistic regression analyses, that identified predictive factors for HbA1c ≤7% (53 mmol/mol).RESULTS:The average age was 63 years, primary/secondary education, health insurance, 10-year type 2 diabetes duration, most associated with cardiovascular risk factors and some microvascular/macrovascular complications; 94.5% received antihyperglycemic drugs. Percentage of people on target: HbA1c 51.2%, blood pressure 23.5%, total cholesterol 62.6%, LDL-cholesterol 38.9% and triglycerides 61.1%. HbA1c on target depended markedly on treatment type: more of those treated with lifestyle changes and significantly fewer of those receiving insulin. Only 4.1% had all parameters simultaneously on target. Multivariate logistic regression analyses showed that achieving HbA1c≤7.0% (53 mmol/mol) was associated with higher educational level, shorter diabetes duration, and having reached goals for LDL-cholesterol and triglycerides, whereas opposite results were obtained with insulin treatment and longer diabetes duration.CONCLUSIONS: High LDL-cholesterol and triglycerides levels simultaneously potentiate development/progression of chronic complications, exerting this effect in the long term by decreasing β-cell mass/function, thereby making it more difficult to reach HbA1c values able to prevent complications.