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Author List:
Jackson G
Edelman D
Objectives:
Describe the degree of simultaneous control of intermediate outcomes among VA diabetic patients, including hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), and diastolic blood pressure (DBP).
Methods:
We established a cohort of 224,221 diabetic patients using the VA Diabetes Registry and Dataset and VA Medical SAS Datasets. Diabetes designation was based on having >=1 filled diabetes related prescription and >=2 outpatient and/or >=1 inpatient encounters with an associated diabetes diagnosis in FY1999. 78,155 cohort members met inclusion/exclusion criteria and had results for all outcomes in FY2000.
Moderate control was defined as simultaneously having mean HbA1c <9.0%, LDL-C <130mg/dL, SBP <140mmHG, and DPB <85mmHG in FY2000. Tight control was simultaneously having mean HbA1c <7.0%, LDL-C <100mg/dL, SBP <130mmHG, and DPB <85mmHG.
Results:
29.68% of patients had moderate control. Percentages for moderate control of individual outcomes were: HbA1c (81.66%), LDL-C (77.39%), SBP (47.87%), and DBP (84.38%). 3.82% of patients had tight control. Percentages for tight control of individual outcomes were: HbA1c (36.18%), LDL-C (40.80%), SBP (26.71%), and DBP (68.73%).
Correlation between outcome types was low. Pearson correlation coefficients were: HbA1c-LDL-C, r=0.12; HbA1c-SBP, r=-0.04; HbA1c-DBP, r=0.08; LDL-C-SBP, r=0.05; LDL-C-DBP, r=0.12; and SBP-DBP, r=0.48.
Having a greater body mass index (BMI), being non-white, and having very low income (indicated by VA means test category) were associated with lower likelihood of achieving simultaneous control. Related odds ratios and 95% confidence intervals for moderate control include: BMI >=40kg/m2 compared to 18-24kg/m2 (0.65 (0.60-0.70)); African American (0.64 (0.60-0.68)), Hispanic-black (0.69 (0.50-0.97)), and Hispanic-white (0.86 (0.79-0.94)) compared to white; and not required to pay VA co-payment because of income compared to required to pay co-payment (0.93 (0.88-0.98)). Related ORs for tight control include: BMI >=40kg/m2 compared to 18-24kg/m2 (0.51 (0.43-0.62)); and African American (0.61 (0.52-0.71)), Hispanic-white (0.75 (0.60-0.92)), and Asian (0.49 (0.24-0.99)) compared to white.
Implications:
Individual treatment characteristics of intermediate diabetes outcomes may need to be considered when developing diabetes treatment plans and evaluating related QUERI initiatives. Assuming overall diabetes control based on one intermediate outcome may be problematic.
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