Longitudinal Trend of Fasting Blood Glucose and Related Factors in Patients with Type 2 Diabetes

Zahra Khatirnamani, Enayatollah Bakhshi, Arash Naghipour, Robab Teymouri, Samaneh Hosseinzadeh


Background: Control of diabetes plays an important role in improving complications and disabilities and quality of life. This study aimed to evaluate the 3‑year changes in fasting blood glucose (FBG) values and its related factors in patients with type 2 diabetes. Methods: In this retrospective cohort study, 500 patients with type 2 diabetes covered by the National Diabetic Prevention and Care Plan during 2013–2016 were selected based on random cluster systematic sampling. A linear mixed model was used to study changes in FBG levels and their related factors. The data were analyzed using the R3.2.0 software. Results: The patients’ mean age was 47.7 years. Among these patients, 58.6% were female, 19.8% had a history of smoking. High FBG was associated with high disease duration, high body mass index (BMI), low age, normal BMI at baseline, insulin therapy, smoking, and family history of diabetes. Trend of FBG in follow‑up was decreasing. Conclusions: Given that patients who received insulin therapy had higher mean FBG, it is recommended to examine their insulin dose and modifications should be made in terms of the patients’ needs during their continuous follow‑up. Weight loss during follow‑up and cessation of smoking indicate a favorable prognosis of disease. More attention should be paid to younger patients in care. Patients are encouraged to start treatment and care at the same time diagnose.


Blood glucose; body mass index; diabetes mellitus type 2; insulin; smoking

Full Text:



American Diabetes Association (ADA). Statistics About

Diabetes, Overall Numbers, Diabetes and Prediabetes. 2017.

Available from: http://www.diabetes.org/diabetes‑basics/

statistics/?loc=db‑slabnav. [Last accessed on on 2017 Sep 05].

Mehdikhani S, Gohari M, Banazade Z. Determining factors

affecting fasting blood sugar in patients with type 2 diabetes

using copula functions. RJMS 2014;21:1‑8.

Hu M, Zhou Z, Zeng F, Sun Z. Effects of frequency of

follow‑up on quality of life of type 2 diabetes patients on oral

hypoglycemics. Diabetes Technol Ther 2012;14:777‑83.

Patel B, Oza B, Patel K, Malhotra S, Patel V. Health related

quality of life in type‑2 diabetic patients in Western India using

World Health Organization Quality of Life – BREF and appraisal

of diabetes scale. Int J Diabetes Dev Ctries 2014;34:100‑7.

Heshmati H, Behnampour N, Khorasani F, Moghadam Z.

Prevalence of chronic complications of diabete and its related

factors in referred type 2 diabetes patients in freydonkenar

diabetes center. J Neyshabur Univ Med Sci 2014;1:36‑43.

Abbasian M, Delvarianzadeh M. Evaluation of diabetes

complications among the diabetic patients visiting the Shahroud

diabetic's clinic. J of knowledge and health 2008;2:16‑20.

Marjani A, Mojerloo M. The metabolic syndrome in

type 2 diabetic subjects in Gorgan, Iran. J Pak Med Assoc


Veissi M, Anari R, Amani R, Shahbazian H, Latifi S.

Mediterranean diet and metabolic syndrome prevalence in type 2

diabetes patients in Ahvaz, Southwest of Iran. Diabetes Metab

Syndr 2016;10:26‑9.

Najafi L, Malek M, Valojerdi AE, Aghili R, Khamseh ME,

Fallah AE, et al. Dry eye and its correlation to diabetes

microvascular complications in people with type 2 diabetes

mellitus. J Diabetes Complications 2013;27:459‑62.

American Diabetes Association (ADA). Introduction. Diabetes

Care 2017;40(Suppl. 1):S1‑2.

American Diabetes Association (ADA). Summary of revisions

to the 2014 clinical practice recommendations. Diabetes Care

;37(Suppl 1):s4.

Esmailnasab N, Afkhamzadeh A, Ebrahimi A. Effective factors

on diabetes control in Sanandaj diabetes center. Iran J Epidemiol


Mahdavi AR, Etemad K, Haider M, Alavinia SM. The effect

of seeing a family physician on the level of glycosylated

hemoglobin (HbA1c) in type 2 diabetes mellitus patients.

J Diabetes Metab Disord 2013;12:2‑7.

Chen C‑C, Cheng S‑H. Continuity of care and changes in

medication adherence among patients with newly diagnosed

diabetes. Am J Manag Care 2016;22:136‑42.

Casteren VFAV, Bossuyt NHE, Moreels SJS, Goderis G,

Vanthomme K, Wens J, et al. Does the Belgian diabetes type 2

care trajectory improve quality of care for diabetes patients?

Arch Public Health 2015;73:31‑42.

Egede LE, Mueller M, Echols CL, Gebregziabher M.

Longitudinal differences in glycemic control by race/ethnicity

among veterans with type 2 diabetes. Med Care 2010;48:527‑33.

Chang SY, Wahlqvist ML, Liu WL, Lee MS, Shin SJ, Li YS,

et al. Management trajectories in the type 2 diabetes integrated

delivery system project in Taiwan: Accounting for behavioral

therapy, nutrition education and therapeutics. Asia Pac J Clin

Nutr 2014;23:592‑606.

Tan NC, Barbier S, Lim WY, Chia KS. 5‑Year longitudinal

study of determinants of glycemic control for multi‑ethnic Asian

patients with type 2 diabetes mellitus managed in primary care.

Diabetes Res Clin Pract 2015;110:218‑23.

Feldstein AC, Nichols GA, Smith DH, Stevens VJ, Bachman K,

Rosales AG, et al. Weight change in diabetes and glycemic and

blood pressure control. Diabetes Care 2008;31:1960‑5.

Hofer SE, Miller K, Hermann JM, DeSalvo DJ, Riedl M, Hirsch IB,

et al. International comparison of smoking and metabolic control in

patients with type 1 diabetes. Diabetes Care 2016;39:177‑8.

Quah JHM, Liu YP, Luo N, How CH, Tay EG. Younger

adult type 2 diabetic patients have poorer glycaemic control:

A cross‑sectional study in a primary care setting in Singapore.

BMC Endocr Disord 2013;13:18‑28.

Vaidya A, Cui L, Sun L, Lu B, Chen S, Liu X, et al.

A prospective study of impaired fasting glucose and type 2

diabetes in China: The kailuan study. Medicine 2016;95:5350‑59.

Kalantarhormozi MR, Siadatan SJ, Aria A, Dabbaghmanesh Mh, Shams M, Sadeghalvad A, et al. Risk factors of diabetes mellitus

in Shiraz City, 2007. Iran J Diabetes Met 2007;7:159‑66.

Rahimi M, Niromand E, Rezaii M. The Relationship between

fasting and postprandial blood glucose with HbA1C in type 2

diabetes. Zumsj 2009;17:45‑53.

Jansen HJ, Hendriks JC, Galan BEd, Penders G, Tack CJ,

Vervoort G. Contribution of change in glycosylated haemoglobin

to insulin‑associated weight gain: Results of a longitudinal study

in type 2 diabetic patients. Endocrine 2011;39:190‑7.

Delavari A, Mahdavi A, Norouzinegad A, Yarahmadi S. Country

Disease Prevention and Control Program. Ministry of Health and

Medical Education, Tehran, Iran: Seda Distribution Center; 2005.

Group DCaCTRG. The effect of intensive treatment of diabetes

on the development and progression of long‑term complication in

insulin dependent diabetes mellitus. N Engl J Med 1993;329:977‑86.

Group UKPDSG. Intensive blood‑glucose control with

sulphonylureas or insulin compared with conventional

treatment and risk of complications in patients with type 2

diabetes (UKPDS 33). Lancet 1998;352:837‑53.

Group TDCaCTR. Lifetime benefits and costs of intensive

therapy as practiced in the diabetes control and complications

trial. The diabetes control and complications trial research group.

JAMA 1996;276:1409‑15.

Cinar FI, Akbayrak N, Cinar M, Karadurmufl N, Fiahin M,

Dogru T, et al. The effectiveness of nurse‑led telephone

follow‑up in patients with type 2 diabetes mellitus. Turkish Jem


Hongm C, Chia K, Hughes K, Ling S. Ethnic differences among

Chinese, Malay and Indian patients with type 2 diabetes mellitus

in Singapore. Singapore Med J 2004;45:154‑60.

Juneja A, Dwivedi S, Srivastava DK, Chandra K. Insulin

resistance in young obese subjects and its relation to smoking (A

pilot study). Indian J Clin Biochem 2017;32:99‑102.

Azimi‑Nezhad M, Ghayour‑Mobarhan M, Parizadeh MR,

Safarian M, Esmaeili H, Parizadeh SMJ, et al. Prevalence of

type 2 diabetes mellitus in Iran and its relationship with gender,

urbanisation, education, marital status and occupation. Singapore

Med J 2008;49:571‑77.