Predicting HbA1c Target Achievement in Type 2 Diabetes: A Retrospective Single-Centre Nomogram Derived From National MMC-Standardised Management.

Abstract

Background: This study assessed the effectiveness of standardized management implemented by the National Metabolic Management Center (MMC) for patients with type 2 diabetes. The goal was to develop a nomogram for predicting HbA1c target achievement.

Methods: A retrospective single-centre study was conducted, including 853 type 2 diabetes patients enrolled in the National Standardized Metabolic Disease Management Center at the Third People's Hospital of Datong City from June 2019 to June 2020. After one year of MMC's standardized management, factors influencing HbA1c achievement were identified through univariate and multivariate analyses to establish a predictive model. Missing data were handled using appropriate imputation methods. Model accuracy and performance were assessed using internal validation and ROC curve analysis.

Results: Significant improvements were observed following MMC's standardized management, including reductions in SBP, FBG, Hb, HCT, MPV, γ-GT, ALB, TG, TC, HbA1c, and LDL-c levels (P<0.05), and increases in AST, BUN, Cr, UA, and HDL-c levels (P<0.05). The absolute HbA1c level decreased, and the rate of achieving the HbA1c target (<7%) was significantly enhanced (P<0.05). Multivariate analysis identified FBG and HCT as independent protective factors for HbA1c achievement, while ALB was a risk factor. The developed predictive model exhibited favorable discriminative ability (c-index: 0.747, 95% CI: 0.703-0.790), confirmed by decision curve analysis.

Conclusion: Standardized MMC management may guide care for type 2 diabetes patients. The predictive model established in this study may assist in improving HbA1c achievement rates, although external validation is needed.