Abstract
Background:
Multiple studies have shown that intensive glycemic control leads to improved HbA1c and delays the onset of complications in diabetes.1 However, improvement in glycemic control has also been associated with weight gain.1 The High A1C (HAC) program uses a multidisciplinary team to provide intensive therapy to patients with HbA1C ≥ 10% over 3 months to improve glycemic control. The aim of this retrospective study is to examine if the HAC program is associated with a significant change in weight and BMI.
Methods:
Patients enrolled in the HAC program were scheduled for frequent visits over the course of 3 months with an Endocrinologist, nurse practitioner, or diabetes educator. Data from patients with type 2 diabetes enrolled from March 2018 to June 2019 who attended at least 2 appointments was collected. Pre-enrollment HbA1c, weight, BMI, and total daily dose (TDD) of insulin (units/kg/day) were compared to post-enrollment using t-test analysis. Use of weight-lowering anti-hyperglycemic agents such as Metformin, GLP-1 agonists (GLP1A) and SGLT-2 inhibitors (SGLT2i) was collected.
Results:
44 patients were enrolled with 39/44 (88.6%) attending at least 2 visits and 5/44 (11.3%) who were lost to follow-up. The median HbA1c improved from 11.5% (9.7-14%) to 8.4% (5.9-14%), p<0.001.There was no significant change in mean weight (195lbs (110-360) vs 192lbs (114-358), p=0.14) or BMI (31 (20-49) vs 31 (21-49) kg/m2, p=0.86). Pre-enrollment, 33/39 (84.6%) patients were on Metformin, 10/39 (25.6%) were on a GLP1A, and 3/39 (7.7%) were on a SGLT2i. At the end of the program, there were 34/39 (87%) patients on Metformin, 26/39 (66.6%) on a GLP1A, and 17/39 (43.5%) on a SGLT2i. There was no difference in the mean TDD of insulin at the start of the program of 0.63 units/kg/day (0-3.52 units/kg/day) compared to 0.60 units/kg/day (0-4.07 units/kg/day) at the end of the program (p=0.97).
Conclusions:
Patients enrolled in a high intensity glycemic control program had significant improvements in HbA1c without change in weight or BMI. Additional adjunctive non-insulin therapies and lifestyle management may be contributing factors for weight neutrality in our population. The significant improvement in HbA1c was not linked with increases in TDD of insulin.
Citation:
1.“U.K. Prospective Diabetes Study Group: Intensive blood glucose control with sulfonylureas or insulin compared with convention treatment and risk of complications in patients with Type 2 Diabetes.” Lancet, vol.353, 1998, pp.837-53.
Influence of intensive glycemic control on development and progression of diabetic nephropathy in patients with type 2 diabetes mellitus (based on results from ADVANCE study)