Observational follow-up of the landmark United Kingdom Prospective Diabetes Study revealed that early tight glycemic control had persistent benefits among adults with newly diagnosed diabetes even a decade after the trial had ended. This phenomenon has been dubbed the “legacy effect” of glycemic control and has not been observed for blood pressure control. The existence of the legacy effect implies that the timing of glycemic control, for example, early vs. late in the disease course, may have clinical consequences. This raises new fundamental diabetes translational research questions. In clinical practice, how soon after diagnosis do patients achieve hemoglobin A1c (A1c) and blood pressure (BP) control and for how long? How do different long-term patterns of control affect future health outcomes? And what do patients believe regarding how and when the timing of therapies to achieve A1c and BP control affects their health outcomes?
Using a large, observational cohort of adults from Kaiser Permanente Northern California with newly diagnosed diabetes (1995-2005), Dr. Laiteerapong will characterize common patterns of a) A1c and b) BP control over ≥10 years of follow-up and compare complications/mortality rates over ≥15 years of follow-up among patients with various 10-year patterns of a) A1c and b) BP control. Then in order to develop a theoretical model for how patients perceive the concept of time in their diabetes-related health decisions, Dr. Laiteerapong will conduct semi-structured interviews with patients with Type 2 diabetes to explore their beliefs regarding the timing of A1c and BP control. The results of these studies will be used to inform a future R01 behavioral intervention focused on improving patient outcomes through effective risk communication and appropriately timed efforts to intensify A1c and BP control.
University of Chicago Bucksbaum Institute Pilot Grant
Chicago Center for Diabetes Translation Research Pilot Grant