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.