Multidomain Cardiorenal-Metabolic Abnormalities Despite HbA1c <7% in Type 2 Diabetes: A Real-World Observational Study

Background: Contemporary management of type 2 diabetes mellitus (T2DM) extends beyond glycemic control and requires comprehensive assessment of cardiovascular, renal, metabolic, and anthropometric factors. Nevertheless, clinical status is often summarized predominantly by glycated hemoglobin (HbA1c), potentially overlooking concurrent non-glycemic abnormalities. This study evaluated the prevalence and coexistence of cardiorenal-metabolic abnormalities among patients with HbA1c <7.0% at six months. Methods: This retrospective observational study included adults with T2DM routinely followed in a specialized outpatient diabetes clinic. The primary descriptive analysis included participants with HbA1c <7.0% at the six-month assessment (T1). Seven non-glycemic cardiorenal-metabolic domains were evaluated at T1: LDL cholesterol, HDL cholesterol, triglycerides, body mass index, blood pressure, estimated glomerular filtration rate, and urinary albumin-to-creatinine ratio. An unweighted descriptive count of domains outside study-defined analytical thresholds was calculated (range, 0–7). An exploratory Poisson regression model examined associations between selected baseline characteristics and the number of affected domains, excluding baseline variables that directly corresponded to components of the T1 count to minimize mathematical coupling. Results: Among 809 participants, 385 (47.6%) had HbA1c <7.0% at six months and were included in the primary descriptive analysis. Concurrent non-glycemic abnormalities were common, particularly for blood pressure, LDL cholesterol, triglycerides, body mass index, and HDL cholesterol. The median number of domains outside study-defined analytical thresholds was three (IQR 3–4), and only three participants (0.8%) had values within all seven thresholds. In the exploratory multivariable model, none of the evaluated demographic, glycemic, or treatment-related baseline characteristics was independently associated with the number of domains outside study-defined thresholds. Conclusions: HbA1c <7.0% at six months did not necessarily coincide with favorable values across other clinically relevant cardiovascular, metabolic, anthropometric, and kidney-related domains in patients with T2DM. The unweighted domain count provides a descriptive summary of concurrent non-glycemic abnormalities but should not be interpreted as a validated measure of risk, prognosis, or clinical risk stratification. These findings support comprehensive, individualized assessment beyond glycemic status alone.