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Aim: To evaluate the association between changes in haemoglobin A1c (HbA1c) and the concurrent incidence of cardiovascular disease (CVD) in type 2 diabetes mellitus (T2DM) patients. Method: We conducted a retrospective cohort study among T2DM patients with HbA1c measurement after T2DM diagnosis between August 2009 and September 2010. The patients were classified into six subgroups based on baseline HbA1c (<7%; 7%–7.9%; ≥8%) and age (<65; ≥65 years), and then clustered into classes by HbA1c trajectory and CVD incidence over the 12‐year follow‐up period using joint latent class mixture models. We explored the HbA1c trajectories and CVD incidences in each latent class. Multinomial logistic regression was used to compare the baseline characteristics among different latent classes. Results: A total of 128 843 T2DM patients were included with a median follow‐up period of 11.7 years. Ten latent classes were identified in patients with baseline HbA1c ≥ 8% and age <65 years, while seven classes were identified in the other five groups. Among all the identified latent classes, patients with fluctuating HbA1c trajectories, characterized by alternating periods of increase and decrease, had higher CVD incidences. Male patients, and patients with higher baseline HbA1c and use of antidiabetic drugs were more likely to have a fluctuating HbA1c trajectory. More specifically, patients aged < 65 years with younger age or a smoking habit, and patients aged ≥ 65 years with a longer duration of T2DM were more likely to have a fluctuating HbA1c trajectory. Conclusion: We found that T2DM patients with fluctuating HbA1c trajectories could have a higher CVD risk. Different trajectory‐associated characteristics in age subgroups highlight the need for individualized management of T2DM patients. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the association between the number of co‐morbidities, all‐cause mortality and public health system expenditure in patients with type 2 diabetes (T2D) across different age groups. Materials and Methods: A retrospective observational study of T2D patients using electronic health records in Hong Kong was conducted. Patients were stratified by age (< 50, 50‐64, 65‐79, ≥ 80 years) and the number of co‐morbidities (0, 1, 2, 3, ≥ 4), defined using the Charlson Comorbidity Index and prevalent chronic diseases identified in local surveys. The association between the number of co‐morbidities, all‐cause mortality and direct medical costs was examined using Cox proportional hazard regression and the gamma generalized linear model with log link function. Results: A total of 262 212 T2D patients with a median follow‐up of 10 years were included. Hypertension and dyslipidaemia were the most common co‐morbidities in all age groups. After age stratification, cardiovascular diseases dominated the top pair of co‐morbidities in the older age groups (65‐79 and ≥ 80 years), while inflammatory and liver disease were predominant among younger individuals. Compared with co‐morbidity–free T2D patients, the hazard ratios (95% CI) of death for patients aged younger than 50 and 80 years or older with two co‐morbidities were 1.31 (1.08‐1.59) and 1.25 (1.15‐1.36), respectively, and increased to 3.08 (2.25‐4.21) and 1.98 (1.82‐2.16), respectively, as the number of co‐morbidities increased to four or more. Similar trends were observed for medical costs. Conclusions: Age‐specific co‐morbidity patterns were observed for patients with T2D. A greater number of co‐morbidities was associated with increased mortality and healthcare costs, with stronger relationships observed among younger patients. [ABSTRACT FROM AUTHOR]

Objective: Cardiovascular diseases (CVD) are a long-term sequela of diabetes. Better individual-based continuity of care has been reported to reduce the risk of chronic complications among patients with diabetes. Maintaining a one-to-one patient-physician relationship is often challenging, especially in public health care settings. This study aimed to evaluate the relationship between higher team-based continuity of care, defined as consultations provided by the same physician team, and CVD risks in patients with diabetes from public primary care clinics.Research Design and Methods: This was a retrospective cohort study in Hong Kong of 312,068 patients with type 2 diabetes and without any history of CVD at baseline (defined as the earliest attendance at a doctor's consultation in a public-sector clinic between 2008 and 2018). Team-based continuity of care was measured using the usual provider continuity index (UPCI), calculated by the proportion of consultations provided by the most visited physician team in the 2 years before baseline. Patients were divided into quartiles based on their UPCI, and the characteristics of the quartiles were balanced using propensity score fine stratification weights. Multivariable Cox regression was applied to assess the effect of team-based continuity of care on CVD incidence. Patient demographics, smoking status, physiological measurements, number of attendances, comorbidities, and medications were adjusted for in the propensity weightings and regression analyses.Results: After an average follow-up of 6.5 years, the total number of new CVD events was 52,428. Compared with patients in the 1st quartile, patients in the 2nd, 3rd, and 4th quartiles of the UCPI had a CVD hazard ratio (95% CI) of 0.95 (0.92-0.97), 0.92 (0.89-0.94), and 0.87 (0.84-0.89), respectively, indicating that higher continuity of care was associated with lower CVD risks. The subtypes of CVD, including coronary heart disease and stroke, also showed a similar pattern. Subgroup analyses suggested that patients <65 years of age had greater benefits from higher team-based continuity of care.Conclusions: Team-based continuity of care was associated with lower CVD risk among individuals with type 2 diabetes, especially those who were younger. This suggests a potential flexible alternative implementation of continuity of care in public clinics. [ABSTRACT FROM AUTHOR]