Background and Objective: Patients with diabetes mellitus (DM) who are at multiple atherosclerotic cardiovascular disease (ASCVD) risk factor (RF) targets have >50% lower ASCVD risks. Limited “real world” data exists on how often such targets are reached. We studied multiple RF target attainment for ASCVD prevention and its indicators in a contemporary DM registry.
Methods: We determined in the U.S. Diabetes Collaborative Registry those at target for HbA1c (<7.0% or <8.0% if with ASCVD), LDL-C (<100 or <70 mg/dl if ASCVD), blood pressure (<130/80 and <140/90 mmHg), and nonsmoking status by sex, race, and prior history of ASCVD. Multiple logistic regression examined indicators of target attainment.
Results: In 45,134 persons with DM (mean age 68.7 years, 41% female) the Table shows achievement of RF targets. Age (>65 [odds ratio, OR=2.3] or 55-64 [OR=1.5] vs. <55), male sex (OR=1.3), white race (OR=1.4), moderate/high intensity statin use (OR=1.2), middle or high income (OR’s 1.2 and 1.4), and (inversely) private insurance (OR=0.9), depression (OR=0.8), and multiple DM medications (OR= 0.9) (all p<0.to p<0.001) were independently associated with being at all 4 targets (including BP<130/80 mmHg).
Conclusions: Less than 1 in 6 U.S. adults with DM are achieving comprehensive RF control. Multifactorial interventions will be necessary to optimize the prevention of ASCVD.
N.D. Wong: Research Support; Self; Amarin Corporation, Amgen Inc.. Speaker's Bureau; Self; Sanofi. Consultant; Self; Pfizer Inc.. Research Support; Self; Pfizer Inc.. Y. Song: None. S.V. Arnold: None. L. Sperling: None. C.P. Cannon: Research Support; Self; Amgen Inc., Arisaph Pharmaceuticals, Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Bristol-Myers Squibb Company, Daiichi Sankyo Company, Limited, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Takeda Pharmaceuticals U.S.A., Inc.. Consultant; Self; Alnylam, Amarin Corporation, Amgen Inc., Arisaph Pharmaceuticals, Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Bristol-Myers Squibb Company, Regeneron Pharmaceuticals, Inc., Sanofi, Eisai Inc., GlaxoSmithKline plc., Kowa Pharmaceuticals America, Inc., Lipimedix, Merck & Co., Inc., Pfizer Inc., Takeda Pharmaceuticals U.S.A., Inc. S. Inzucchi: Other Relationship; Self; Boehringer Ingelheim Pharmaceuticals, Inc., AstraZeneca, Novo Nordisk Inc., Sanofi, Lexicon Pharmaceuticals, Inc.. Consultant; Self; VTV Therapeutics. Other Relationship; Self; Intarcia Therapeutics, Inc.. Consultant; Self; Janssen Pharmaceuticals, Inc., Alere Inc. M. Kosiborod: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca, Amgen Inc., Sanofi, Boehringer Ingelheim GmbH, GlaxoSmithKline plc., Glytec Systems, Merck & Co., Inc., Novo Nordisk A/S, Janssen Pharmaceuticals, Inc., ZS Pharma, Inc., Intarcia Therapeutics, Inc., Novartis AG. Research Support; Self; AstraZeneca, Boehringer Ingelheim GmbH.