Simultaneous control of intermediate diabetes outcomes among veterans affairs primary care patients
Received: 09 November 2005 Revised: 27 January 2006 Accepted: 05 April 2006 DOI:
Cite this article as: Jackson, G.L., Edelman, D. & Weinberger, M. J GEN INTERN MED (2006) 21: 1050. doi:10.1111/j.1525-1497.2006.00519.x Abstract Guidelines recommend tight control of hemoglobin Alc (HbAlc), 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. BACKGROUND: Describe the degree of simultaneous control of HbAlc, LDL-C, and BP among Veterans Affairs (VA) diabetes patients defined by both VA and American Diabetes Association (ADA) guidelines. OBJECTIVE: Cross-sectional cohort. DESIGN: Eighty-thousand two hundred and seven VA diabetes patients receiving care between October 1999 and September 2000. PATIENTS: We defined simultaneous control of outcomes using 1997 VA Guidelines (in place in 2000) (HbAlc<9.0%; LDL-C<130 mg/dL; systolic BP<140mmHg; and diastolic BP<90mmHg) and 2004 ADA guidelines (HbAlc<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. MEASURMENTS: Using VA guidelines, 31% of patients had simultaneous control. Control levels of individual outcomes were: HbAlc (82%), LDL-C (77%), and BP (48%). Using ADA guidelines, 4% had simultaneous control. Control levels of individual outcomes were: HbAlc (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 HbAlc (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 HbAlc 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. RESULTS: While the proportion of patients who achieved minimal levels of control of HbAlc and LDL-C was high, these data indicate a low level of simultaneous control of HbAlc, LDL-C, and BP among patients with diabetes. CONCLUSION: Key words blood pressure diabetes mellitus hemoglobin A-glycosylated lipoproteins-LDL cholesterol United States Department of Veterans Affairs
Preliminary results were presented at the American Public Health Association Annual Meeting in Washington, DC, on November 9, 2004 and VA Health Services Research & Development National Meeting in Baltimore, MD, on February 17, 2005.
He is currently a Veterans Affairs Health Services Research & Development Merit Review Entry Program awardee (VA grant MRP 05-312). Dr. Weinberger is a VA Health Services Research & Development Senior Career Scientist awardee. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
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