Medical University of South Carolina and Department of Veterans Affairs, Charleston, SC, United States.
The Biostatistics Center, Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Rockville, MD, United States.
Diabetes Res Clin Pract. 2022 Feb;184:109188. doi: 10.1016/j.diabres.2021.109188. Epub 2021 Dec 28.
We evaluated differences in participants with type 2 diabetes (T2DM) enrolled in the GRADE study at VA vs non-VA sites, focusing on cardiovascular risk factors and rates of diabetes care target achievements.
We compared baseline characteristics between participants at VA (n = 1216) and non-VA (n = 3831) sites, stratifying analyses by cardiovascular disease (CVD) history.
VA and non-VA participants had similar diabetes duration (4.0 years), HbA1c (7.5%), and BMI (34 kg/m); however, VA participants had more individuals ≥ 65 years (37.3% vs 19.8%, p < 0.001), men (90.0% vs 55.2%, p < 0.001), hypertension (75.8% vs 63.6%, p < 0.001), hyperlipidemia (76.6% vs 64.6%, p < 0.001), current smokers (19.0% vs 12.1%, p < 0.001), nephropathy (20.4% vs 17.0%, p < 0.05), albuminuria (18.4% vs 15.1%, p < 0.05), and CVD (10.4% vs 5.2%, p < 0.001). In those without CVD, more VA participants were treated with lipid (70.8% vs 59.5%, p < 0.001) and blood pressure (74.9% vs 65.4%, p < 0.001) lowering medications, and had LDL-C < 70 mg/dl (32.9% vs 24.2%, p < 0.05). Among those with CVD, more VA participants had BP < 140/90 (80.2% vs 70.1%, p < 0.05) after adjusting for demographics.
GRADE participants at VA sites had more T2DM complications, greater CVD risk and were more likely to be treated with medications to reduce it, leading to more LDL-C at goal than non-VA participants, highlighting differences in diabetes populations and care.
我们评估了在 VA 和非 VA 地点参加 GRADE 研究的 2 型糖尿病（T2DM）患者之间的差异，重点关注心血管危险因素和糖尿病治疗目标的达标率。
我们比较了 VA（n=1216）和非 VA（n=3831）地点参与者的基线特征，按心血管疾病（CVD）病史进行分层分析。
VA 和非 VA 参与者的糖尿病病程（4.0 年）、HbA1c（7.5%）和 BMI（34kg/m²）相似；然而，VA 参与者中有更多年龄≥65 岁的个体（37.3%比 19.8%，p<0.001）、男性（90.0%比 55.2%，p<0.001）、高血压（75.8%比 63.6%，p<0.001）、高血脂（76.6%比 64.6%，p<0.001）、当前吸烟者（19.0%比 12.1%，p<0.001）、肾病（20.4%比 17.0%，p<0.05）、白蛋白尿（18.4%比 15.1%，p<0.05）和 CVD（10.4%比 5.2%，p<0.001）。在没有 CVD 的患者中，更多的 VA 参与者接受了降脂（70.8%比 59.5%，p<0.001）和降压（74.9%比 65.4%，p<0.001）药物治疗，且 LDL-C<70mg/dl（32.9%比 24.2%，p<0.05）。在 CVD 患者中，调整人口统计学因素后，更多的 VA 参与者的血压<140/90（80.2%比 70.1%，p<0.05）。
VA 地点的 GRADE 参与者有更多的 T2DM 并发症、更高的 CVD 风险，并且更有可能接受降低 CVD 风险的药物治疗，导致 LDL-C 达标率高于非 VA 参与者，突出了糖尿病患者群体和护理的差异。
