Glycemic and non-glycemic targets in younger and older North Indian subjects with XXXX 2 @entity6 in a Tertiary care hospital: A 10 year's retrospective data analysis.

@entity1 @entity6 @entity164 @entity1011 @entity1602 @entity413 @entity165
BACKGROUND: Although optimizing glycemic and non-glycemic targets reduced micro- and macro-vascular complications in @entity164 2 @entity6 , multiple barriers hinder turning evidence into practice. Mounting evidence suggests that those with onset of disease in early or mid-adult life, compared with those with onset at an older age, may have a more severe disease course and worse glycemic control. AIMS _ OBJECTIVE: We tested the hypothesis that those diagnosed at younger age would have worse glycemic control, even after adjustment for duration of @entity6 , higher BMI and other known risk factors for worse glycemic control. MATERIALS _ METHODS: A cross-sectional analysis of 560 @entity164 2 @entity6 subjects from North Indian populace in the year 1999-2012 who reported to endocrine clinic was performed. Sixty @entity1 did not report in the successive year and final data analyses were done in 500 @entity1 attending clinic regularly over a period of 10 years for evaluation of glycemic and non-glycemic targets. They were followed up at 3 monthly intervals with all @entity1 undergoing anthropometric measurement (BMI (weight in kg/height in m(2)), diet and lifestyle advice by a @entity6 educator and consultation by endocrinologist. Fasting and postprandial plasma @entity413 , A1c (3 monthly), besides evaluation of SMBG that was performed in 50% of these @entity1 regularly. Fasting lipids, S. @entity1011 and microalbuminuria were assessed annually and blood pressure recoding was done at each visit. The treatment was modified as per the investigation reports. We classified age at @entity6 diagnosis as younger (<60 years) vs older (>= 60 years). The primary outcome of interest was HbA1c >= 9%. Secondary outcomes were HbA1c >= 8% to <9% and HbA1c >= 7% to <8%. RESULTS: After adjustment for sex, duration of @entity6 , @entity1602 medications, BMI, co-morbid conditions, age <60 years at diagnosis remains significantly associated with greater odds of HbA1c >= 9% [OR 0.95(0.84-1.07)], HbA1c >= 8% to <9% [OR 1.04(0.93-1.15)] and HbA1c >= 7% to <8% [OR 1.05(0.85-1.17)] for female sex. Seventy two (72.7%) of @entity1 <60 years achieved BP <140/90mmHg (p<0.001) as compared to 62.3% of @entity1 >= 60 years who achieved BP <150/90mmHg (p<0.001) and LDL- @entity165 <100mg/dl in 33.7% @entity1 and 39.1% respectively (p<0.002). CONCLUSION: Younger age (<60 years) at @entity164 2 @entity6 diagnosis is significantly associated with worse subsequent glycemic control and lipid control, as younger @entity1 at diagnosis have fewer competing co-morbidities and complications. As @entity1 -centeredness is a priority in @entity164 2 @entity6 care, safe, aggressive and individualized treatment could benefit this higher-risk group.
