Glycemic and Cholesterol Control Versus Single-Goal Control in US Veterans with Newly Diagnosed Type 2 Diabetes: A Retrospective Observational Study

Abstract

Introduction: A majority of patients with diabetes do not have levels of glycated hemoglobin (HbA1c) and low-density lipoprotein cholesterol (LDL-C) under control, either individually or in combination. The objective was to assess the clinical benefits and patient characteristics associated with dual-goal achievement [HbA1c <7% (53 mmol/mol) and LDL-C <100 mg/dL] versus only LDL-C goal achievement in adults with newly diagnosed type 2 diabetes. Methods: Newly diagnosed patients with ≥2 measures of LDL-C and HbA1c were identified in the South Central Veterans Affairs Health Care Network (01/2004–06/2010). The index date was the first HbA1c assessment within 3 months of the first type 2 diabetes diagnosis. Multivariate Cox proportional hazards models were used to assess the association between time-varying goal achievement and post-index microvascular and cardiovascular complications. Patient characteristics associated with dual-goal achievement in the 7–12 months post-index were identified using a logistic regression. Results: The sample included 16,829 patients. Compared with LDL-C goal achievement, dual-goal achievement was associated with lower risk of microvascular complications [hazard ratio (95% confidence interval): 0.69 (0.63, 0.76)]. Other outcomes did not differ between those two groups. Characteristics associated with dual-goal achievement (44.2% of patients) include prior dual-goal achievement, older age, and use of lipid-lowering drugs. Conclusion: Dual-goal achievement in newly diagnosed type 2 diabetes is associated with a lower risk of microvascular complications versus only LDL-C goal achievement. Although dual-goal achievement rates are suboptimal, early and regular intervention will increase its likelihood. Funding: Daiichi Sankyo, Inc., Parsippany, NJ, USA.