Latent class trajectory modeling of glycated hemoglobin over a 13-year period in a large sample of outpatients with type 2 diabetes

Author(s): Micol Sechi, Beatrice Amico & Giacomo Zoppini

Background: Glucose control depends on several factors such as social, economic, mental health, substance abuse, and eating behavior among other factors. The complexity of glucose control trajectories poses significant challenges especially when long-term care is required.

Aim: To identify different latent classes of glycated hemoglobin trend in order to better individualize therapy of diabetes.

Methodology: In this retrospective observational study 8989 adult patients with type 2 diabetes attending the diabetes clinic of Verona during the year 2007-2020 were analyzed. We applied LCMM with the goal of identifying patients belonging to subgroups with different trajectories of glycated hemoglobin. A multivariate logistic model was used to identify variables associated to class with worsening trend with respect to that with a stable trend.

Results: Class 1, with the improving trend, contained 630 (7.01%) of patients; class 2, the stable trend, 7975 (88.52%); and class 3, the worsening trend, 402 (4.47%) of patients. Subjects of class 3 were significantly younger, whereas those of class1 were more frequently women, with a longer duration of diabetes and a worse glycemic control. The multivariate logistic model with the dependent variable worsening trend versus stable trend, showed that age was associated with a reduced probability of worsening trend, duration of diabetes increased the risk of a worsening trend as did women.

Conclusion: In conclusion, our study shows that most of the patients with type 2 diabetes followed a stable trend of glycated hemoglobin, and only less than 5% of patients follow a deteriorating trend.