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Regularity of follow-up, glycemic burden, and risk of microvascular complications in patients with type 2 diabetes: a 9-year follow-up study

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Abstract

Aims

To assess the relationship between regularity of follow-up and risk of complications in patients with type 2 diabetes (T2DM) followed up for 9 years at a tertiary diabetes center in India.

Methods

We compared glycemic burden [cumulative time spent above a HbA1c of 53 mmol/mol (7 %)] and incidence of diabetes complications (retinopathy, neuropathy, nephropathy, peripheral arterial disease, coronary heart disease) between 1,783 T2DM patients with “regular follow-up” (minimum of three visits and two HbA1c tests every year from 2003 to 2012), and 1,798 patients with “irregular follow-up” (two visits or less and one HbA1c or less per year during the same time period), retrospectively identified from medical records. Cox proportional hazards models were used to estimate risk associated with diabetes complications.

Results

Compared to those with regular follow-up, the irregular follow-up group had significantly higher mean fasting and postprandial plasma glucose, HbA1c, glycemic burden, total and LDL cholesterol, and triglycerides at every time point during the 9 years of follow-up. Those with irregular follow-up had double the total and mean monthly glycemic burden and 1.98 times higher risk of retinopathy (95 % CI 1.62, 2.42) and 2.11 times higher risk of nephropathy (95 % CI 1.73, 2.58) compared to those with regular follow-up, even after adjusting for time-varying confounding variables. Complications tended to develop significantly earlier and were more severe in those with irregular follow-up.

Conclusion

Among patients with type 2 diabetes, regular follow-up was associated with significantly lower glycemic burden and lower incidence of retinopathy and nephropathy over a 9-year period.

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Acknowledgments

We thank the staff of Dr.Mohan’s Diabetes Specialities Centre and Madras Diabetes Research Foundation, Chennai for their help with this study. We also thank Ms. S. Jebarani, Senior Manager – Software, Dr. Mohan’s Diabetes Specialities Centre for retrieving the data and Dr. P. Venkatesan, Assistant Director & Head, Department of Statistics, Tuberculosis Research Centre, Chennai for helping with the analysis.

Conflict of interest

Ranjit Mohan Anjana, Coimbatore Subramanian Shanthirani, Ranjit Unnikrishnan, Poongkunran Mugilan, Anandakumar Amutha, Haridas Divya Nair, Sivasankaran Subhashini, Ulagamathesan Venkatesan, Mohammed K Ali, Harish Ranjani, Viswanathan Mohan declare that they have no conflict of interest.

Ethical standard

This study was approved by the Institutional Ethics Committee of the Madras Diabetes Research Foundation, Chennai, India.

Human and animal rights disclosure

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent disclosure

Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Madras Diabetes Research Foundation and Dr. Mohan’s Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases Prevention and Control & IDF Centre of Education, 4, Conran Smith Road, Gopalapuram, Chennai, 600086, India

    Ranjit Mohan Anjana, Coimbatore Subramanian Shanthirani, Ranjit Unnikrishnan, Poongkunran Mugilan, Anandakumar Amutha, Haridas Divya Nair, Sivasankaran Subhashini, Ulagamathesan Venkatesan, Harish Ranjani & Viswanathan Mohan

  2. Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Mohammed K. Ali

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  1. Ranjit Mohan Anjana
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  2. Coimbatore Subramanian Shanthirani
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Correspondence to Ranjit Mohan Anjana.

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Anjana, R.M., Shanthirani, C.S., Unnikrishnan, R. et al. Regularity of follow-up, glycemic burden, and risk of microvascular complications in patients with type 2 diabetes: a 9-year follow-up study. Acta Diabetol 52, 601–609 (2015). https://doi.org/10.1007/s00592-014-0701-0

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