Scientific Programme
Year 2021
October 2021


Abstract Title
Glycaemic control and risk of diabetes-related potentially avoidable hospitalisations

H.L.HTUN.1, W.LIAN.1, R.H.F.LIM.1, D.E.K.CHEW.1, W-Y.LIM.1


Tan Tock Seng Hospital1

Background & Hypothesis

Little is known about the longitudinal trajectory of glycated haemoglobin (HbA1c) and its impact on potentially avoidable hospitalization (PAH). We evaluated the association between HbA1c trajectories and subsequent one-year risk of diabetes-related PAH in a group of diabetics managed in an outpatient setting.


We performed a retrospective cohort study of adult prevalent type 2 diabetes patients managed at specialist outpatient medical clinics in Tan Tock Seng Hospital from 2009-2017. Glycaemic control was assessed by longitudinal trajectory of HbA1c (≥3HbA1c measurements within a two-year period) using group-based trajectory modelling. We ascertained composites of PAH (short-/long-term diabetic complications/uncontrolled diabetes/lower-extremity amputation) from principal discharge diagnoses, using definitions by the Prevention Quality Indicators (Version2020). Poisson regression models were used to estimate risk ratio (RR) and 95% confidence interval (95%CI).


A total of 7710 patients were eligible. Four distinct HbA1c trajectories were found: low-stable (n=6205,80.5%), moderate-stable (n=1021,13.2%), high-persistent (n=203,2.6%), and high-decrease (n=281,3.6%). During one-year follow-up, 36.4%(n=2807) patients were admitted at least once. Of these, 5.2%(n=147/2807) were admitted for diabetes-related PAHs. Compared to low-stable group, high-persistent group had the highest risk of diabetes-related PAH (RR:3.90; 95%CI:2.15-7.08) followed by high-decrease group (RR:1.50, 95%CI: 0.68-3.30) and the moderate-stable group (RR:1.42, 95%CI:0.85-2.37), after adjusting for potential confounders.

Discussion & Conclusion

Our results suggest that distinct HbA1c trajectories were associated with diabetes PAH in the subsequent year. Patients who achieved good glycaemic control following an extremely high HbA1c, had a lower risk compared to those with persistently high HbA1c.