Optimizing treatment goals for long-term health outcomes among patients with type 2 diabetes mellitus
Introduction Considerable confusions on treatment target have resulted from recent changes in guidelines. Evidence in medical guidelines came from clinical trials with highly selected patients, whereas treatment goals may differ in some subgroups. This study aimed to assess optimal treatment goals (...
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BMJ Publishing Group
2021-03-01
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| Series: | BMJ Open Diabetes Research & Care |
| Online Access: | https://drc.bmj.com/content/9/1/e002396.full |
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| author | Lizheng Shi Yilu Lin Qian Shi Vivian A Fonseca |
| author_facet | Lizheng Shi Yilu Lin Qian Shi Vivian A Fonseca |
| author_sort | Lizheng Shi |
| collection | DOAJ |
| description | Introduction Considerable confusions on treatment target have resulted from recent changes in guidelines. Evidence in medical guidelines came from clinical trials with highly selected patients, whereas treatment goals may differ in some subgroups. This study aimed to assess optimal treatment goals (A1C, blood pressure, low-density lipoprotein cholesterol (LDL-C)) for patients with type 2 diabetes mellitus (T2DM), which lead to optimal health outcomes by different treatment strategies.Research design and methods A retrospective longitudinal study was conducted for veterans with T2DM by using US Veterans Affairs Administrative Database (2005−2015). Medical records were prepared for repeated evaluation performed at 6-month intervals and multivariate longitudinal regression was used to estimate the risk of microvascular and macrovascular complication events. Second-degree polynomial and splines were applied to identify the optimal goals in their associations with lowest risk of clinical outcomes, controlling for demographic characteristics, medical history, and medications.Results A total of 124 651 patients with T2DM were selected, with mean of 6.72 follow-up years. In the general population, to achieve the lowest risk of microvascular and macrovascular complication, the optimal goals were A1C=6.81%, LDL-C=109.10 mg/dL; and A1C=6.76%, LDL-C=111.65 mg/dL, systolic blood pressure (SBP)=130.60 mmHg, respectively. The optimal goals differed between age and racial subgroups. Lower SBP for younger patients and lower LDL-C for black patients were associated with better health outcomes.Conclusions Optimal treatment goals were identified and multi-faceted treatment strategies targeting hyperglycemia and hyperlipidemia and hypertension may improve health outcome in veterans with T2DM. In addition to guidelines’ recommended goals, health systems may examine their own large diverse patients with T2DM for better quality of care. |
| format | Article |
| id | doaj-art-0b14f2a8fa9248c3adbe96aae4c16045 |
| institution | OA Journals |
| issn | 2052-4897 |
| language | English |
| publishDate | 2021-03-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Diabetes Research & Care |
| spelling | doaj-art-0b14f2a8fa9248c3adbe96aae4c160452025-08-20T01:59:09ZengBMJ Publishing GroupBMJ Open Diabetes Research & Care2052-48972021-03-019110.1136/bmjdrc-2021-002396Optimizing treatment goals for long-term health outcomes among patients with type 2 diabetes mellitusLizheng Shi0Yilu Lin1Qian Shi2Vivian A Fonseca3Department of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USADepartment of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USADepartment of Health Policy and Management, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USASection of Endocrinology and Metabolism, John W. Deming Department of Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana, USAIntroduction Considerable confusions on treatment target have resulted from recent changes in guidelines. Evidence in medical guidelines came from clinical trials with highly selected patients, whereas treatment goals may differ in some subgroups. This study aimed to assess optimal treatment goals (A1C, blood pressure, low-density lipoprotein cholesterol (LDL-C)) for patients with type 2 diabetes mellitus (T2DM), which lead to optimal health outcomes by different treatment strategies.Research design and methods A retrospective longitudinal study was conducted for veterans with T2DM by using US Veterans Affairs Administrative Database (2005−2015). Medical records were prepared for repeated evaluation performed at 6-month intervals and multivariate longitudinal regression was used to estimate the risk of microvascular and macrovascular complication events. Second-degree polynomial and splines were applied to identify the optimal goals in their associations with lowest risk of clinical outcomes, controlling for demographic characteristics, medical history, and medications.Results A total of 124 651 patients with T2DM were selected, with mean of 6.72 follow-up years. In the general population, to achieve the lowest risk of microvascular and macrovascular complication, the optimal goals were A1C=6.81%, LDL-C=109.10 mg/dL; and A1C=6.76%, LDL-C=111.65 mg/dL, systolic blood pressure (SBP)=130.60 mmHg, respectively. The optimal goals differed between age and racial subgroups. Lower SBP for younger patients and lower LDL-C for black patients were associated with better health outcomes.Conclusions Optimal treatment goals were identified and multi-faceted treatment strategies targeting hyperglycemia and hyperlipidemia and hypertension may improve health outcome in veterans with T2DM. In addition to guidelines’ recommended goals, health systems may examine their own large diverse patients with T2DM for better quality of care.https://drc.bmj.com/content/9/1/e002396.full |
| spellingShingle | Lizheng Shi Yilu Lin Qian Shi Vivian A Fonseca Optimizing treatment goals for long-term health outcomes among patients with type 2 diabetes mellitus BMJ Open Diabetes Research & Care |
| title | Optimizing treatment goals for long-term health outcomes among patients with type 2 diabetes mellitus |
| title_full | Optimizing treatment goals for long-term health outcomes among patients with type 2 diabetes mellitus |
| title_fullStr | Optimizing treatment goals for long-term health outcomes among patients with type 2 diabetes mellitus |
| title_full_unstemmed | Optimizing treatment goals for long-term health outcomes among patients with type 2 diabetes mellitus |
| title_short | Optimizing treatment goals for long-term health outcomes among patients with type 2 diabetes mellitus |
| title_sort | optimizing treatment goals for long term health outcomes among patients with type 2 diabetes mellitus |
| url | https://drc.bmj.com/content/9/1/e002396.full |
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