Simultaneous control of intermediate diabetes outcomes among veterans affairs primary care patients
- 1 October 2006
- journal article
- research article
- Published by Springer Science and Business Media LLC in Journal of General Internal Medicine
- Vol. 21 (10), 1050-1056
- https://doi.org/10.1111/j.1525-1497.2006.00519.x
Abstract
BACKGROUND: Guidelines recommend tight control of hemoglobin Alc (HbAlc), low-density lipoprotein cholesterol (LDL-C), and blood pressure (BP) for patients with diabetes. The degree to which these intermediate outcomes are simultaneously controlled has not been extensively described. OBJECTIVE: Describe the degree of simultaneous control of HbAlc, LDL-C, and BP among Veterans Affairs (VA) diabetes patients defined by both VA and American Diabetes Association (ADA) guidelines. DESIGN: Cross-sectional cohort. PATIENTS: Eighty-thousand two hundred and seven VA diabetes patients receiving care between October 1999 and September 2000. MEASURMENTS: We defined simultaneous control of outcomes using 1997 VA Guidelines (in place in 2000) (HbAlcRESULTS: Using VA guidelines, 31% of patients had simultaneous control. Control levels of individual outcomes were: HbAlc (82%), LDL-C (77%), and BP (48%). Using ADA guidelines, 4% had simultaneous control. Control levels of individual outcomes were: HbAlc (36%), LDL-C (41%), and BP (23%). Associations between individual risk factors were weak. There was a modest association between LDL-C control and control of HbAlc (odds ratio [OR] 1.51; 95% confidence interval [CI] 1.44, 1.58). The association between LDL-C and BP control was clinically small (1.26: 1.21, 1.31), and there was an extremely small association between BP and HbAlc control (0.95; 0.92, 0.99). Logistic regression modeling indicates greater body mass index, African American or Hispanic race-ethnicity, and female gender were negatively associated with simultaneous control. CONCLUSION: While the proportion of patients who achieved minimal levels of control of HbAlc and LDL-C was high, these data indicate a low level of simultaneous control of HbAlc, LDL-C, and BP among patients with diabetes.Keywords
This publication has 48 references indexed in Scilit:
- Clinical Inertia Contributes to Poor Diabetes Control in a Primary Care SettingThe Diabetes Educator, 2005
- Prevalence of Patients with Type 2 Diabetes Mellitus Reaching the American Diabetes Association’s Target Guidelines in a University Primary Care SettingSouthern Medical Journal, 2004
- IntroductionDiabetes Care, 2004
- Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood PressureHypertension, 2003
- Racial Disparities in Diabetes Care Processes, Outcomes, and Treatment IntensityMedical Care, 2003
- Management of Chronic Disease by PatientsAnnual Review of Public Health, 2003
- Interventions to Improve the Management of Diabetes in Primary Care, Outpatient, and Community SettingsDiabetes Care, 2001
- Diabetes guidelines: A summary and comparison of the recommendations of the american diabetes association, veterans health administration, and american association of clinical endocrinologistsClinical Therapeutics, 2000
- Diabetes in urban African-Americans. XVI. Overcoming clinical inertia improves glycemic control in patients with type 2 diabetes.Diabetes Care, 1999
- Metabolic control and morbidity of Type 2 diabetic patients in a general practice networkFamily Practice, 1999