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A patient's age at the time of diagnosis of type 2 diabetes is the strongest nongenetic predictor of the change in glycated hemoglobin (A1C) over time, according to research presented at the 42nd annual meeting of the European Association for the Study of Diabetes (EASD), held September 14–17 in Copenhagen, Denmark.
Targ Elgzyri, MD, and colleagues at Lund University in Malmö, Sweden, studied the progression of the disease in 1,209 people diagnosed with type 2 diabetes who were included in a diabetes registry in southern Sweden.1
Researchers measured a variety of processes to assess participants' glycemic control, including fasting plasma glucose and fasting C-peptide, as well as beta-cell function and insulin resistance. Body mass index (BMI) was recorded at the beginning and end of the study. A1C levels were measured repeatedly during the 7-year follow-up.
A1C levels were noted to improve slightly 1 year after diagnosis, then progressively rise over the next 6 years, from an average of 6.3% to 7.0%. A1C levels were inversely related to beta-cell function.
Insulin therapy was initiated 2.5 years after diagnosis, on average. After 7 years, 47% of participants were on insulin therapy.
Researchers observed that participants who were <50 years of age at the time their diabetes was diagnosed had a steeper increase in A1C levels than those who were >50 when diagnosed. No relationship was seen between A1C levels and sex, insulin resistance, BMI at diagnosis, or ethnicity.
"Early age at diagnosis was the strongest predictor of A1C increase over time," Elgzyri says.
The findings provide a basis to test whether genetic factors can modify the relationships among beta-cell function, age, and A1C levels, he says.
Other observers suggest that the results are an early warning of clinical challenges that will be posed by managing diabetes in the future.
"The figures are quite frightening because it will be quite difficult
to control diabetes in these patients over the years," says Pierre J.
Lefebvre, MD, president of the International Diabetes Federation and emeritus
professor of medicine at the University of Liege in Belgium. 
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