Department of Global Health Management and Policy, School of Public Health and Tropical Medicine, Tulane University, United States.
Department of Medicine, School of Medicine and Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, United States.
Diabetes Res Clin Pract. 2018 Jun;140:45-54. doi: 10.1016/j.diabres.2018.02.013. Epub 2018 Mar 27.
This study was designed to compare the risk of long-term health outcomes, including microvascular, macrovascular complications and mortality, across 4 cohorts: triple-goal, dual-goal, single-goal, and no-goal achievers.
A retrospective cohort of 53,120 patients with T2DM were identified (97.51% male, 61.49% whites) from the Veterans Affairs (VA) electronic medical records VISN 16 data warehouse (2004-2010). Propensity score weight (PSW) was used to balance demographic characteristics and complication history at baseline. The PSW adjusted hazard ratios (aHR) from Cox proportional hazard models were used to compare complications and all-cause mortality over an average of 4 years of follow-up.
At baseline, 25.43% (13,507) patients achieved triple-goal, while 41.36% (21,972) and 26.37% (14,010) patients achieved dual-goal and single-goal, respectively. During the follow-up period, triple-goal achievement was associated with risk reductions of complications and all-cause mortality when compared to all other groups of achieving dual or single-goal. Across different combinations of dual-goal achievement, the cohort with LDL-C goal achievement had lower risk of complication events and mortality, compared to those that achieved other goals but failed to reach LDL-C goal.
Achievement of triple-goal was associated with better health outcomes among veterans with T2DM compared to those that did not, while LDL-C has more weight of influence. Multi-faceted treatment strategies targeting hypertension, hyperglycemia and hyperlipidemia may improve health outcome in veterans with T2DM.
本研究旨在比较 4 个队列的长期健康结果风险，包括微血管、大血管并发症和死亡率：三目标达标组、双目标达标组、单目标达标组和无目标达标组。
从退伍军人事务部（VA）电子病历 VISN 16 数据仓库（2004-2010 年）中确定了 53120 名 T2DM 患者的回顾性队列（97.51%为男性，61.49%为白人）。使用倾向评分权重（PSW）来平衡基线时的人口统计学特征和并发症史。使用 Cox 比例风险模型的 PSW 调整后的风险比（aHR）来比较平均 4 年随访期间的并发症和全因死亡率。
在基线时，25.43%（13507）名患者达到了三目标，而 41.36%（21972）和 26.37%（14010）名患者分别达到了双目标和单目标。在随访期间，与其他双目标或单目标达标组相比，三目标达标与并发症和全因死亡率风险降低相关。在不同的双目标达标组合中，与其他目标达标但未达到 LDL-C 目标的患者相比，达到 LDL-C 目标的患者并发症事件和死亡率风险较低。
与未达标者相比，T2DM 退伍军人达到三目标与更好的健康结果相关，而 LDL-C 具有更大的影响权重。针对高血压、高血糖和高血脂的多方面治疗策略可能会改善 T2DM 退伍军人的健康结果。
