Journal of General Internal Medicine

, Volume 21, Issue 10, pp 1050–1056

Simultaneous control of intermediate diabetes outcomes among veterans affairs primary care patients

  • George L. Jackson
  • David Edelman
  • Morris Weinberger
Original Articles

DOI: 10.1111/j.1525-1497.2006.00519.x

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

BACKGROUND: 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.

OBJECTIVE: 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.

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) (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.

RESULTS: 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.

CONCLUSION: 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.

Key words

blood pressurediabetes mellitushemoglobin A-glycosylatedlipoproteins-LDL cholesterolUnited States Department of Veterans Affairs

Copyright information

© Society of General Internal Medicine 2006

Authors and Affiliations

  • George L. Jackson
    • 1
    • 2
  • David Edelman
    • 1
    • 2
  • Morris Weinberger
    • 1
    • 3
  1. 1.Durham Veterans Affairs Medical CenterHSR&D Service (152)Durham
  2. 2.Division of General Internal MedicineDuke UniversityDurhamUSA
  3. 3.Department of Health Policy and AdministrationUniversity of North Carolina at Chapel HillChapel HillUSA