Abstract P047: Improved Clinical Outcomes Associated with Dual-Goal (HbA1c and LDL-C) Achievement in Newly Diagnosed Type 2 Diabetes Mellitus

Abstract

Background: Compared with studies on achieving a single goal of either glycated hemoglobin (HbA1c) or low-density lipoprotein cholesterol (LDL-C) in type 2 diabetes mellitus (T2DM), the clinical benefits of dual-goal achievement (LDL-C<100 mg/dl and HbA1c<7%) are not well documented. This study investigated factors and clinical benefits associated with dual-goal achievement in newly diagnosed T2DM patients. Methods: Newly diagnosed adult T2DM patients with ≥2 measures of LDL-C and HbA1c were identified in the Veterans Integrated Services Network 16 data warehouse (01/2004-06/2010). A logistic regression model was used to identify factors associated with dual-goal achievement during 7-12 months following the index date (first HbA1c recorded within three months of the first T2DM diagnosis). Factors included demographics and 0-6 month dual-goal achievement, as well as diabetes-related comorbidities, medications, surgeries, and healthcare utilization, all measured during the 1-year period surrounding the index date. Multivariate Cox proportional hazards models were used to assess the association between time-varying goal achievement status and post-index date clinical outcomes, including microvascular complications (retinopathy, nephropathy, and neuropathy), cardiovascular-related complications (cardiovascular death, stroke, or myocardial infarction) and acute coronary syndromes (ACS). Results: A total of 16,829 T2DM patients were included in the study. Factors associated with an increased likelihood of dual-goal achievement include older age, higher Charlson Comorbidity Index (CCI), prior dual-goal achievement, diagnosis of ketoacidosis or hypersmolarity, and lipid-lowering drug use. Conversely, patients with prior diagnoses of retinopathy, neuropathy, and congestive heart failure, as well as prior insulin use were less likely to achieve both goals. Compared with failure to achieve either goal, achieving only LDL-C goal was associated with a lower risk of cardiovascular-related complications (HR:0.76; 95% CI:0.71-0.81) and ACS (HR:0.76; 95% CI:0.67-0.86), while achieving only HbA1C goal was associated with a lower risk of microvascular complications (HR:0.73; 95% CI:0.71-0.74), cardiovascular-related complications (HR:0.80; 95% CI:0.74-0.87) and ACS (HR:0.66; 95% CI:0.60-0.72). Dual-goal achievement was associated with additional reduction in risk of microvascular complications (HR: 0.69; 95% CI: 0.63-0.76) vs. only LDL-C goal achievement, but had similar risk to achieving HbA1c goal alone. Conclusions: Older age, higher CCI, prior dual-goal achievement, and lipid-lowering drug use were associated with a greater likelihood of dual-goal achievement. Dual-goal achievement in newly diagnosed T2DM patients is associated with decreased risks of microvascular complications than those with only LDL-C goal achievement.