Cardiovascular Risk Factor Burden in People With Incident Type 2 Diabetes in the U.S. Receiving Antidiabetic and Cardioprotective Therapies

• Published in: Diabetes care Vol. 42; no. 4; pp. 644 - 650
• Main Authors: Montvida, Olga, Cai, Xiaoling, Paul, Sanjoy K
• Format: Journal Article
• Language: English
• Published: United States American Diabetes Association 01.04.2019
• Subjects: Antidiabetics; Antihypertensives; Blood pressure; Cardiovascular diseases; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Electronic health records; Electronic medical records; Health risks; Levels; Lipids; Low density lipoprotein; Medical research; Metformin; Patients; Population studies; Research design; Risk analysis; Risk factors; Risk management; Triglycerides; United States > US
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc18-1865

Individualized treatment of patients with diabetes requires detailed evaluation of risk factor dynamics at the population level. This study evaluated the persistent glycemic and cardiovascular (CV) risk factor burden over 2 years after treatment intensification (TI). From U.S. Centricity Electronic Medical Records, 276,884 patients with incident type 2 diabetes who intensified metformin were selected. Systolic blood pressure (SBP) ≥130/140 mmHg and LDL ≥70/100 mg/dL were defined as uncontrolled for those with/without a history of CV disease at TI. Triglycerides ≥150 mg/dL and HbA ≥7.5% (58 mmol/mol) were defined as uncontrolled. Longitudinal measures over 2 years after TI were used to define risk factor burden. With 3.7 years' mean follow-up, patients were 59 years; 70% were obese; 22% had a history of CV disease; 60, 30, 50, and 48% had uncontrolled HbA , SBP, LDL, and triglycerides, respectively, at TI; and 81% and 69% were receiving antihypertensive and lipid-modifying therapies, respectively. The proportion of patients with consistently uncontrolled HbA increased from 31% in 2005 to 41% in 2014. Among those on lipid-modifying drugs, 41% and 37% had consistently high LDL and triglycerides over 2 years, respectively. Being on antihypertensive therapies, 29% had consistently uncontrolled SBP. Among patients receiving cardioprotective therapies, 63% failed to achieve control in HbA + LDL, 57% in HbA + SBP, 55% in LDL + SBP, and 63% in HbA + triglycerides over 2 years after TI. Among patients on multiple therapies for risk factor control, more than one-third had uncontrolled HbA , lipid, and SBP levels, and more than one-half had two CV risk factors that were simultaneously uncontrolled after TI.