Three-year trajectories of metabolic risk factors predict subsequent long-term mortality in patients with type 2 diabetes

Aim This study aims to evaluate the associations between 3-year trajectories of metabolic risk factors and subsequent mortality in patients with type 2 diabetes. Methods A total of 6400 persons aged ≥ 30 years with type 2 diabetes and ≥ 3 years of follow-up period were included. The cluster analysis determined the patterns of 3-year trajectories, and Cox proportional hazards models evaluated the associations between patterns and mortality. Results Three trajectory subgroups of metabolic risk factors, namely, cluster 1, normal; cluster 2, high–stable or reducing with high level at baseline; and cluster 3, fluctuation: elevated and decreasing, were generated. The clusters 2 and 3 of body mass index (BMI), fasting plasma glucose (FPG), HbA1c, and triglyceride (TG) trajectories were associated with increased risks of all-cause mortality compared with cluster 1 (hazard ratio = 1.27, 95% confidence interval = 1.06–1.51 and 1.45, 1.19–1.78 for BMI; 1.41, 1.22–1.62 and 1.81, 1.38–2.38 for FPG; 1.42, 1.23–1.64 and 1.47, 1.23–1.75 for HbA1c; 1.34, 1.10–1.63 and 2.40, 1.30–4.37 for TG, respectively). For the systolic blood pressure trajectory, only cluster 3 was associated with an increased mortality risk relative to cluster 1 (1.76, 1.13–2.77). Conclusions Long-term metabolic risk factor trajectories may be associated with subsequent mortality.