Featured Article :

Clinical and Economic Benefits Associated With the Achievement of Both HbA1c and LDL

Cholesterol Goals in Veterans With Type 2 Diabetes

Featured Article:

Lizheng Shi, P.H.D., Xin Ye, P.H.D., Mei Lu, M.S., Eric Q. Wu, P.H.D., Hari Sharma, B.S., Darren Thomason, B.A., Vivian A. Fonseca, M.D.

Diabetes Care Volume 36: 3297-3304

October, 2013

STUDY OBJECTIVE

• This study compared the clinical and economic benefits of dual-goal achievement:

• HbA1c <7% (53 mmol/mol)• LDL cholesterol (LDL-C) <100 mg/dL

• Achievement of only the LDL-C goal or only the HbA1c goal was achieved in veterans with T2DM

Shi L. et al. Diabetes Care 2013;36:3297-3304

STUDY DESIGN AND METHODS

• Electronic medical records (Veterans Integrated Service Network 16) were evaluated in adult T2DM patients with two or more measurements of LDL-C and HbA1c between 1 January 2004 and 30 June 2010

• Cox proportional hazards models were used to compare microvascular and cardiovascular outcomes by goal achievement status

• Generalized linear regression models were used to assess diabetes-related resource use (hospitalization days and number of outpatient visits) and medical service costs


RESULTS

• Relative to achieving only the LDL-C goal, dual-goal achievement was associated with lower risk of microvascular complications, acute coronary syndrome, percutaneous coronary intervention, and coronary artery bypass graft (CABG)

• Dual-goal achievement was also associated with fewer hospitalization days and outpatient visits, as well as lower diabetes-related annual medical costs

• Compared with achievement of only the HbA1c goal, dual-goal achievement was associated with lower risk of the composite cardiovascular-related end point and CABG, as well as fewer outpatient visits






CONCLUSIONS

• Achieving both HbA1c and LDL-C goals in diabetes care is associated with additional clinical and economic benefits, compared with the achieving either goal alone


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