RT Journal Article
SR Electronic
T1 Optimising HbA1c monitoring intervals in patients with type 2 diabetes based on glycaemic control status: a target trial emulation study
JF BJGP Open
JO BJGP Open
FD Royal College of General Practitioners
SP BJGPO.2025.0020
DO 10.3399/BJGPO.2025.0020
A1 Wang, Boyuan
A1 Tse, Emily Tsui Yee
A1 Li, Shugang
A1 Wu, Hao
A1 Chui, Celine Sze Ling
A1 Lam, Cindy Lo Kuen
A1 Wan, Eric Yuk Fai
YR 2025
UL http://bjgpopen.org/content/early/2025/10/31/BJGPO.2025.0020.abstract
AB Background The appropriate HbA1c monitoring intervals for patients with type 2 diabetes mellitus (T2DM) remain unclear.Aim To determine appropriate HbA1c monitoring intervals for T2DM patients across different glycaemic control categories.Design & setting A target trial emulation study using electronic health recordsMethod Adult T2DM patients from 2009 to 2012 were identified and grouped by baseline HbA1c levels:<7.0% (<53 mmol/mol), 7.0-7.9% (53–63 mmol/mol), 8.0-8.9% (64–74 mmol/mol), and≥9.0% (≥75 mmol/mol). A pre-specified target trial was emulated for each group to evaluate the impact of various HbA1c monitoring intervals on the risk of all-cause mortality and cardiovascular diseases (CVD). Compared intervals were every 2–4, 5–8, 9–15, and 16–24 months for HbA1c<7.0%, and every 2–4, 5–8, and 9–24 months for HbA1c≥7.0%. Follow-up continued until the earliest occurrence of the outcome, death, or December 31, 2021.Results The cohort included 183,078 patients. For those with HbA1c<7%, extending the HbA1c monitoring interval to every 16-24 months did not increase the risk outcome compared to 2-4-month intervals. Patients with baseline HbA1c between 7-7.9% faced a significantly higher mortality risk when monitored at 9-24-month versus 2-4-month intervals (HR [95% CI]: 1.10 [1.05,1.15]). Moreover, for those with HbA1c≥8%, monitoring every 5-8 months increased the risk of mortality and/or CVD compared to 2-4-month intervals (HR [95% CI] for HbA1c 8-8.9%: 1.10 [1.04,1.16] for all-cause mortality, 1.04 [0.98,1.10] for CVD; HR [95% CI] for HbA1c≥9%: 1.25 [1.18,1.33] for all-cause mortality, and 1.09 [1.02,1.17] for CVD).Conclusions For T2DM patients with HbA1c<7%, monitoring can be extended to 1.5–2 years. For those with HbA1c 7.0-7.9% and≥8%, recommended intervals are six and three months, respectively. (293 words)