Primary Care Research

Simultaneous control of risk factors for diabetes complications is difficult to achieve

Control of blood glucose (HbA1c), low-density lipoprotein cholesterol (LDL-C), and blood pressure (BP) is associated with reduced risk of diabetes-related complications. Yet according to a new study, only one-third of veterans with diabetes achieved simultaneous control of these three risk factors. Moreover, control of one risk factor had little association with control of another risk factor. Thus, clinicians cannot assume that aggressive pursuit of controlling one risk factor will result in control of other risk factors, concludes George L. Jackson, Ph.D., M.H.A., of the Durham Veterans Affairs Medical Center.

However, study results showed a significant relationship between body mass index (BMI) and all risk factors, indicating that clinicians may want to focus on weight reduction as one approach for reducing several risk factors for diabetes-related complications. Researchers examined simultaneous achievement of blood glucose, cholesterol, and blood pressure control among 8,207 patients with diabetes cared for at Veteran Administration (VA) hospitals in 1999 and 2000. They defined simultaneous control of outcomes using both 1997 VA guidelines and the more stringent 2004 American Diabetes Association (ADA) guidelines.

Based on VA guidelines (HbA1c less than 9 percent, LDL-C less than 130 mg/dL, and BP less than 140/90 mm Hg), 31 percent of patients achieved simultaneous control. Control levels of individual outcomes were HbA1c (82 percent), LDL-C (77 percent), and BP (48 percent). Using the ADA guidelines (HbA1c less than 7 percent, LDL-C less than 100 mg/dL, and BP less than 130/80 mm Hg), only 4 percent achieved simultaneous control, and control levels of individual outcomes were HbA1c (36 percent), LDL-C (41 percent), and BP (23 percent). Associations between individual risk factors were weak. However, women, individuals with greater BMI, and blacks and Hispanics were less likely to achieve simultaneous control. The researchers caution that they lacked data on important confounding factors, such as individual exercise, diet, and smoking status. The study was supported in part by the Agency for Healthcare Research and Quality (HS00079).

See "Simultaneous control of intermediate diabetes outcomes among Veterans Affairs primary care patients," by Dr. Jackson, David Edelman, M.D., M.H.S., and Morris Weinberger, Ph.D., in the October 2006 Journal of General Internal Medicine 21, pp. 1050-1056.

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