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Maxwell Stem, Taylor Blachley, Roni M Shtein, William Herman, Thomas Gardner, Joshua D Stein; Impact of Diagnosing Diabetic Complications on Subsequent Hemoglobin A1c Levels. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1459. doi: https://doi.org/.
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The impact of a new diagnosis of a diabetes mellitus (DM)-related complication on glycemic control is unknown. This study tested the hypothesis that receipt of a new diagnosis of a complication from DM would lead to improved HbA1c values.
We used a nationwide, longitudinal managed care network claims database (2001 - 2011) to identify all patients with DM who experienced an initial diabetes complication (e.g. diabetic retinopathy, neuropathy, nephropathy, myocardial infarction (MI), or stroke) and who had ≥ 1 HbA1c value measured prior to the complication and ≥ 1 HbA1c measurement after the complication. A paired t-test was used to compare mean HbA1c levels before the initial complication was diagnosed to mean HbA1c levels following the diagnosis of the first complication.
518 enrollees met the study inclusion criteria. Diabetic neuropathy was most frequently diagnosed as the initial complication from diabetes (n = 148 persons (29%)), followed by nephropathy (n = 143 (28%)), MI/stroke (n = 123 (24%)), retinopathy (n = 84 (16%)), and foot ulcer (n = 20 (4%)). Patients with suboptimally controlled DM (defined as HbA1c > 7 %, n = 177 (34%)) prior to the diagnosis of their first complication demonstrated a clinically significant reduction in average HbA1c following the diagnosis of their first complication (mean pre-complication HbA1c = 8.5 ± 1.5% vs. mean post-complication HbA1c = 7.9 ± 1.7%, p < 0.0001).
Enrollees with suboptimally controlled diabetes may be motivated to achieve better glycemic control following the diagnosis of a diabetes-related complication. The results from this study may provide a rationale for the earlier detection of complications from DM, even if the complications are not directly treatable, because simply diagnosing these conditions may incentivize patients to improve their diabetes management (thus reducing the incidence of future complications).
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