PAPER DETAILS

OBJECTIVE
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).

RESEARCH DESIGN AND METHODS
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.

RESULTS
With 3.7 years' mean follow-up, patients were 59 years, 70% 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(s) 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.

CONCLUSIONS
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.