The Health Impact of Getting to Glucose, Systolic Blood Pressure (SBP), and Serum Cholesterol Goals in Patients Newly Diagnosed with Type 2 Diabetes Mellitus (T2DM) in Canada

Abstract

Good management of T2DM requires not only control of blood glucose, but control of SBP and serum cholesterol levels as well. Unfortunately, goal attainment is difficult and many patients in Canada and elsewhere do not meet these targets. The objective of this research was to estimate the potential health benefits (reduced incidence of micro- and macrovascular events and increased survival) of two treatment scenarios attributable to treating newly-diagnosed patients to the glucose, SBP and cholesterol goals specified in the CDA guidelines (7.0 percent (%), 130 mmHg and 77 mg/dL, respectively) versus levels observed in a T2DM population tailored to the Canadian setting (8.0%, 140 mmHg and 112 mg/dL, respectively) using a validated simulation tool, the Economic and Health Outcomes (ECHO)-T2DM model over 25 years. Pharmacotherapy for hyperglycemia, hypertension, and hypercholesterolemia in line with CDA guidelines were applied to both treatment scenarios. Treating patients to CDA goals was estimated to reduce the relative risk of myocardial infarction by 31%, congestive heart failure by 12%, stroke by 24%, ischemic heart disease by 25%, macular edema by 34%, end stage renal disease by 26.9%, and macroalbuminuria by 56.5% over 25 years. Estimated survival was on average, approximately 4 months longer for patients treated to CDA goals. These results suggest that intensifying therapy to achieve key biomarker goals in patients newly diagnosed with T2DM can lead to meaningful gains in long-term health outcomes in Canada.