Session number: 1115
Abstract title: Cardiovascular risk factor control among veterans with diabetes
Author(s):
NL Smith - Seattle ERIC, VA Puget Sound Health Care System
L Chen - University of Rochester Medical Center
DH Au - HSR&D, VA Puget Sound Health Care System
M McDonell - HSR&D, VA Puget Sound Health Care System
SD Fihn - HSR&D, VA Puget Sound Health Care System
Objectives: To describe the extent to which hyperglycemia, hypertension, and dyslipidemia are currently detected, treated, and controlled in US veterans with diabetes with and without ischemic heart disease (IHD).
Methods: 3769 veterans who self-reported diabetes and who received all health care from Veteran Affairs (VA) medical centers were selected from subjects enrolled in the Ambulatory Care Quality Improvement Project, a randomized health services intervention at 7 VA primary care clinics. IHD was defined by a self-reported history of myocardial ischemia, infarction, or revascularization. Mean values of hemoglobin A1c (HbA1c), blood pressure, and cholesterol sub-fractions were collected from computerized laboratory databases. Medication data were collected from computerized pharmacy databases.
Results: Mean HbA1c and optimal control (HbA1c<7%) did not differ for those without and with IHD: 8.1% and 8.0%; 26% and 24%, respectively. Veterans with IHD were more likely to have hypertension (73% versus 64%), to be treated (88% versus 78%), and to have optimal blood pressure control (19% versus 10%) compared to veterans without IHD, all p-values <0.01. Veterans with IHD were more likely to have dyslipidemia (81% versus 53%), were equally likely to be treated (54% versus 50%) and were more likely to have optimal LDL levels (30% versus 16%) compared to veterans without IHD, all p-values <0.01.
Conclusions: Optimal cardiovascular risk factor control was the exception in this cohort of diabetic veterans attending primary care clinics.
Impact statement: More aggressive management of cardiovascular risk factors in veterans with diabetes may be warranted, especially among those without prevalent IHD.