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

BACKGROUND

Guidelines recommend tight control of hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol (LDL-C), and blood pressure (BP) for patients with diabetes. The degree to which these intermediate outcomes are simultaneously controlled has not been extensively described.

OBJECTIVE

Describe the degree of simultaneous control of HbA1c, LDL-C, and BP among Veterans Affairs (VA) diabetes patients defined by both VA and American Diabetes Association (ADA) guidelines.

DESIGN

Cross-sectional cohort.

PATIENTS

Eighty-thousand two hundred and seven VA diabetes patients receiving care between October 1999 and September 2000.

MEASURMENTS

We defined simultaneous control of outcomes using 1997 VA Guidelines (in place in 2000) (HbA1c < 9.0%; LDL-C < 130 mg/dL; systolic BP < 140 mmHg; and diastolic BP < 90 mmHg) and 2004 ADA guidelines (HbA1c < 7.0%; LDL-C < 100 mg/dL; systolic BP < 130 mmHg; and diastolic BP < 80 mmHg). A patient is considered to have simultaneous control of the intermediate outcomes for a given definition if the average of measurements for each outcome was below the defined threshold during the study period.

RESULTS

Using VA guidelines, 31% of patients had simultaneous control. Control levels of individual outcomes were: HbA1c (82%), LDL-C (77%), and BP (48%). Using ADA guidelines, 4% had simultaneous control. Control levels of individual outcomes were: HbA1c (36%), LDL-C (41%), and BP (23%). Associations between individual risk factors were weak. There was a modest association between LDL-C control and control of HbA1c (odds ratio [OR] 1.51; 95% confidence interval [CI] 1.44, 1.58). The association between LDL-C and BP control was clinically small (1.26; 1.21, 1.31), and there was an extremely small association between BP and HbA1c control (0.95; 0.92, 0.99). Logistic regression modeling indicates greater body mass index, African American or Hispanic race-ethnicity, and female gender were negatively associated with simultaneous control.

CONCLUSION

While the proportion of patients who achieved minimal levels of control of HbA1c and LDL-C was high, these data indicate a low level of simultaneous control of HbA1c, LDL-C, and BP among patients with diabetes.