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Published on: June 11, 2012

Simultaneous control of intermediate diabetes outcomes among Veterans Affairs primary care patients

George L Jackson1, David Edelman, Morris Weinberger

  • 1Durham Veterans Affairs Medical Center, Durham, NC, USA. george.l.jackson@duke.edu

Journal of General Internal Medicine
|September 15, 2006
PubMed

Insights

Simultaneous control of hemoglobin A1c (HbA1c), LDL cholesterol (LDL-C), and blood pressure (BP) is low in diabetes patients. While individual targets are often met, achieving all three concurrently remains a challenge.

Area of Science:

  • Cardiovascular Medicine
  • Endocrinology
  • Public Health

Background:

  • Current guidelines recommend strict control of hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol (LDL-C), and blood pressure (BP) for diabetes management.
  • However, the extent to which these critical intermediate outcomes are simultaneously controlled in patient populations is not well-documented.

Purpose of the Study:

  • To assess the degree of simultaneous control of HbA1c, LDL-C, and BP in Veterans Affairs (VA) diabetes patients.
  • This evaluation was performed using both the 1997 VA guidelines and the 2004 American Diabetes Association (ADA) guidelines.

Main Methods:

  • A cross-sectional cohort study was conducted.
  • The study included 80,207 VA diabetes patients treated between October 1999 and September 2000.
  • Simultaneous control was defined by achieving target levels for HbA1c, LDL-C, and BP according to both VA and ADA criteria.

Main Results:

  • Using VA guidelines (HbA1c < 9.0%, LDL-C < 130 mg/dL, BP < 140/90 mmHg), 31% of patients achieved simultaneous control.
  • Under stricter ADA guidelines (HbA1c < 7.0%, LDL-C < 100 mg/dL, BP < 130/80 mmHg), only 4% of patients had simultaneous control.
  • Individual outcome control rates were higher (HbA1c 82%, LDL-C 77%, BP 48% for VA; HbA1c 36%, LDL-C 41%, BP 23% for ADA), but associations between achieving control for individual factors were weak.

Conclusions:

  • Despite high rates of achieving individual targets for HbA1c and LDL-C, simultaneous control of HbA1c, LDL-C, and BP is notably low in this VA diabetes patient cohort.
  • Factors such as higher body mass index, African American or Hispanic race-ethnicity, and female gender were associated with lower odds of simultaneous control.
Abstract

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