Association of Novel Clinical and Behavioural Markers with HbA1c Improvement: A Latent Class Analysis of 912 Patients with Type 2 Diabetes Mellitus.

Objective: The escalating prevalence of Type 2 Diabetes Mellitus (T2DM) overwhelms healthcare systems. Lifestyle interventions enhancing patient monitoring and adherence vary in efficacy, emphasizing the need to understand differential response across patient subgroups. This study aimed to segment patients with T2DM into distinct latent classes and identify characteristics associated with optimal 12-month glycated haemoglobin (HbA1c) reduction.

Methods: We prospectively recruited 1000 patients with T2DM from government-funded outpatient clinics in Singapore, aged ≥ 40-year-old with HbA1c ≥ 7.0 %. Exclusion criteria included insulin treatment and cognitive impairment. Latent class analysis was applied to 912 patients, using mHealth interventions, age, education, living arrangement, baseline HbA1c, step count, and motivation (Patient Activation Measure) as indicators. 12-Month HbA1c reduction was assessed with one-way ANOVA and pairwise T-test.

Results: Within cohort, younger patients with higher education, physical activity, and baseline HbA1c exhibited the greatest HbA1c improvement (1.14 ± 1.79 %). Younger patients with lower education, despite high baseline HbA1c, exhibited a moderately lower HbA1c improvement (0.52 ± 1.41 %).

Conclusion: Individuals with higher baseline HbA1c, education, motivation, and activity levels experienced the most significant HbA1c reductions in response to lifestyle interventions. A tailored approach to these modifiable characteristics may help patients achieve substantial 12-month HbA1c reductions.