EFFECTS OF DELAYS IN GLYCEMIC CONTROL ON COMPLICATIONS IN MIDDLE-AGED ADULTS WITH NEW ONSET DIABETES

Purpose: The United Kingdom Prospective Diabetes Study (UKPDS) clearly demonstrated the benefits of intensive glycemic control in middle-aged patients with new-onset diabetes.  In clinical practice, achievement of intensive glucose control goals is oftentimes delayed by years.  We set out to quantify the risks associated with different periods of delays in achieving optimal glycemic control. 

Method: Using a diabetes complication model based on UKPDS, we simulated lifetime complication rates, quality-adjusted life years (QALYs) and life expectancy (LE), for delays in achieving optimal glycemic control (hemoglobin A1c [HbA1c] 7.0%) compared to suboptimal control (HbA1c 8.0%).  The hypothetical populations were healthy, non-smoking U.S. adults, aged 40-49 and 50-59 years old with new-onset diabetes.  We systematically considered delays in achieving optimal control from one to ten years.

Result: For 40-49 year olds (yo), a lifetime of suboptimal versus optimal control produced an absolute risk increase (ARI) of 22.4% (95% confidence interval (CI) 21.2-23.7) of any diabetes complication and losses of 345 QALDs and 290 life days (LDs).  For 50-59 yo, a lifetime of suboptimal control produced an ARI of 18.9% (CI 17.7-20.2) of any complication and losses of 202 QALDs and 263 LDs.  Increasing treatment delays produced larger losses in QALYs and LE.  For 40-49 yo, one-year delays resulted in losses of 5 QALDs and 5 LDs, five-year delays produced losses of 50 QALDs and 44 LDs, and ten-year delays produced losses of 126 QALDs and 110 LDs.  For 50-59 yo, one-year delays caused losses of 3 QALDs and 2 LDs, five-year delays resulted in losses of 40 QALDs and 26 LDs, and ten-year delays produced losses of 118 QALDs and 87 LDs.  For 40-49 yo, ten-year delays caused 36.7% (QALYs) and 37.7% (LE) decrements in the potential maximum benefit of a lifetime of optimal compared to sub-optimal control.  For 50-59 yo, ten-year delays were associated with 44.7% (QALY) and 44.1% (LE) reductions in the potential maximum benefits of immediate glycemic control.

Conclusion: Delays in achieving optimal glycemic control of £10 years lead to losses of over 30% of potential benefits of therapy in U.S. middle-aged healthy adults with new-onset diabetes.  Physicians and patients should be aware that although large delays in optimal control can produce significant reductions in benefits, most benefits remain even when optimal control is delayed over 10 years.