Glycated haemoglobin trajectories and one-year risk of potentially avoidable hospitalisations among adult patients with type 2 diabetes from specialist outpatient clinics of a tertiary hospital: A cohort study
Authors' conclusion
Patients with high-decrease trajectory had a risk lower than those with persistently-high HbA1c, highlighting that a greater risk of hospitalisation conferred by poor glycaemic control is potentially reversible. Determining HbA1c trajectories could help to identify the high-risk individuals for targeted and intensive management to improve care and reduce hospitalisations.
Study context
- Population
- Adults with T2D with ≥ 3 HbA1c tests over two years, specialist outpatient clinics of a tertiary hospital in Singapore; mean age 62.9 ± 12.8 years, 55.2% men
- Participants
- 14,923 adults
- Exposure
- HbA1c trajectories vs low-stable
- Low-stablen = 9,854reference
- Moderate-stablen = 3,125
- High-decreasen = 1,017
- High-persistentn = 927
- Outcome
- Potentially avoidable hospitalisations (PAH; Agency of Healthcare Research and Quality criteria): overall, diabetes, acute and chronic composites
- Follow-up
- One year after the last HbA1c reading
Methodological detailssingle tertiary hospital, group-based trajectory modelling
- Single tertiary hospital
- Group-based trajectory modelling
Main finding
As reported in the abstract
Overall PAH · one year
Each group vs low-stableRelative risk (95% CI)
Moderate-stable
1.15(1.00–1.31)
High-decrease
1.53(1.31–1.80)
High-persistent
1.96(1.58–2.43)
Observational data: associations, not effects.
Further findings
| Outcome | RR (95% CI) | |
|---|---|---|
| Diabetes PAH · one yearModerate-stablevs Low-stable | 1.30 (1.04–1.64) | |
| Diabetes PAH · one yearHigh-decreasevs Low-stable | 1.98 (1.55–2.53) | |
| Diabetes PAH · one yearHigh-persistentvs Low-stable | 2.24 (1.59–3.15) | |
| Acute PAH · one yearModerate-stablevs Low-stable | 1.14 (0.90–1.44) | |
| Acute PAH · one yearHigh-decreasevs Low-stable | 1.29 (0.95–1.77) | |
| Acute PAH · one yearHigh-persistentvs Low-stable | 1.75 (1.17–2.62) | |
| Chronic PAH · one yearModerate-stablevs Low-stable | 1.21 (1.02–1.43) | |
| Chronic PAH · one yearHigh-decreasevs Low-stable | 1.62 (1.34–1.97) | |
| Chronic PAH · one yearHigh-persistentvs Low-stable | 2.14 (1.67–2.75) | |
| 0.20.5125Relative risk (log scale) |
Mean HbA1c and potentially avoidable hospitalisations (PAH)
- Mean HbA1c significantly associated with overall and chronic-composite PAH; evidence of a non-linear relationship with diabetes-composite PAH
Original publication
Glycated haemoglobin trajectories and one-year risk of potentially avoidable hospitalisations among adult patients with type 2 diabetes from specialist outpatient clinics of a tertiary hospital: A cohort study. Diabetes Res Clin Pract. Published 5 June 2023. doi:10.
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