#1706812 Age-Related Glycemic Trends in Type 2 Diabetes presenting with Complications over a decade of Standard Care Treatment

An increasing prevalence of T2DM onset at younger ages increases the chances of exposure to complications over their lifetime with diabetes. Contemporary evidence suggests that every decade of earlier diagnosis of diabetes was associated with about 3–4 years of lower life expectancy. Therefore, intensive guideline directed approach is especially useful to manage T2DM in younger people who present with any complication at their first visit. We conducted a longitudinal observational study, across two centres, in patients who reported with any complication (microvascular or macrovascular) and were enrolled as part of the standard care plan. We included the patients who had atleast one visit within an interval of six months (n=10,251). We categorised the cohorts into three age groups young (≤40 years) YAG, middle age (41-60 years) MAG and elderly ( >60 years) EAG. The distribution of the predominant complication was quite varied. Peripheral neuropathy was observed in 24.2%, 18.2% had retinopathy, 33.9% had microalbuminuria, 4.5% presented with macroalbuminuria, and 9.7% patients had serum creatinine >1.3 mg/dL. Of these 5955, 2190, 1662 and 444 patients had documented atleast two, three, four and five follow up visits, respectively. Overall, the mean HbA1c at baseline was 8.4 (±2, 95% CI 8.3 to 8.4), which at the last documented follow up visit was significantly reduced to 7.9 (±1.7, 95% CI 7.8 to 7.9), p< 0.0001. The mean reduction in HbA1c % in age group ≤40, 41 to 60, >60 years was – 0.8 (±2.1, 95% CI -1 to -0.5), -0.4 (±2, 95% CI -0.6 to -0.3), and -0.4 (±1.9, 95% CI -0.5 to -0.3), respectively, The difference was statistically significant p=0.0114. The HbA1c at baseline in the YAG (n=1095) was 8.6 (±2.4, 95% CI 8.3 to 8.8), which reduced to 7.8 (±2, 95% CI 7.6 to 8), p< 0.0001. The HbA1c at baseline in the MAG (n=4623) was 8.5 (±2.2, 95% CI 8.4 to 8.6), which reduced to 8 (±1.7, 95% CI 7.9 to 8.1), p< 0.0001. The HbA1c at baseline in the EAG (n=4533) was 8.2 (±1.9, 95% CI 8.1 to 8.3), which reduced to 7.7 (±1.5, 95% CI 7.7 to 7.8), p< 0.0001. There was no significant correlation in the difference between the reduction in HbA1c in YAG and MAG, (Pearson r 0.0004, 95% CI -0.01 to 0.1, p=0.99 ns) and between YAG and EAG (Pearson r -0.022, 95% CI -0.12 to 0.08, p=0.67 ns). Our study demonstrates a significant reduction in HbA1c levels across various age groups, with the mean HbA1c decreasing from 8.4 to 7.9 over multiple follow-up visits in a real world setting. Notably, the greatest improvement was observed in the youngest age group (≤40 years). These findings highlight the effectiveness of our guideline directed management approach in managing T2DM in patients with varying age demographics, especially the ones presenting with complications.