by Colin Kenny, GP, Dromore
Researchers in Scotland used data collected in primary care to explore what factors were predictive of the rate at which type 2 diabetes progresses following diagnosis, recognising that this can be highly variable between individuals. They examined 5250 individuals with type 2 diabetes using the comprehensive electronic medical records on all patients in Tayside, Scotland, from 1992 onwards.
The team attempted to establish if there was an association between clinical, biochemical or genetic factors and the risk of progression of type 2 diabetes. They defined progression as a instigation of insulin treatment or an HbA1c level ≥69 mmol/mol (8.5%) treated with two or more non-insulin diabetes therapies (thought of, together, as simply a requirement for insulin treatment).
It was found that the risk of progression was associated with a low or a high BMI. Furthermore, when the data were stratified by both BMI and HbA1c at the time of diagnosis, an increased rate of progression was found to be independently associated with earlier age at diagnosis, elevated log triacylglyceride (essentially, triglyceride) concentrations and lower HDL-cholesterol levels.
Genetic risk scores were derived from 61 “diabetes risk variants”; these were not associated with the rate of progression to requirement for insulin treatment. The genetic factors that may predispose an individual to diabetes are different from those associated with rapid progression of diabetes and this is something that, in the view of the authors, merits further investigation.
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