ABC Goals Research Articles

A cascade of care for diabetes in people living with HIV in a tertiary care center in Mexico City

Background Diabetes affects 4.5% of people living with HIV in Mexico. This study aims to describe the diabetes cascade of care (DMC) in people with HIV in a tertiary center in Mexico City. Methods We conducted a single-center review of people with HIV aged over 18, using medical records of active people enrolled at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ) HIV Clinic (HIVC). Our analysis focused on their last visit to describe the DMC, aiming to identify gaps in control goals. We included people who had a consultation within the 12 months preceding May 2020. Results Out of the 2072 active people, medical records were available for 2050 (98.9%). Among these, 326 people (15.9%) had fasting glucose (FG) abnormalities, of which 133 (40.7%) had diabetes. The prevalence of diabetes among people with HIV was of 6.4% (133/2050). Regarding the DMC, the following proportions of people achieved control goals: 133/133 (100%) received medical care in the last 12 months, 123/123 (100%) had blood pressure (BP) <140/90 mmHg, 73/132 (55.3%) had LDL cholesterol (c-LDL) <100 mg/dl, 63/132 (47.7%) had FG <130 mg/dl, 50/116 (43.1%) had glycosylated hemoglobin (HbA1c) <7%. ABC goals (HbA1c <7%, c-LDL <100 mg/dl, BP <140/90 mmHg) were met in 28/109 (25.6%) people. 126/133 (94%) people with HIV achieved HIV-viral load <50 copies/mL. Conclusions Despite the high rate of viral suppression among people with HIV and diabetes, significant challenges remain in achieving comprehensive diabetes control. These findings highlight the need for targeted interventions to improve metabolic outcomes and the overall management of diabetes in people with HIV.

The correlation of ABC goal attainment with insulin resistance/sensitivity in Syrian type 2 diabetes patients

BackgroundThe rising prevalence of type 2 diabetes (T2D) in Syria emphasizes the urgent requirement for effective management approaches. The ABC goals, which include maintaining glycated hemoglobin levels below 7 %, blood pressure below 140/90 mmHg, and low-density lipoprotein cholesterol levels below 100 mg/dl, serve as crucial benchmarks for managing T2D and its associated comorbidities. MethodsIn this cross-sectional study, the achievement of ABC goals was retrospectively examined among 681 clinically diagnosed T2D patients (not on Insulin) who participated in a six-year online lifestyle intervention program for diabetes management at the Freedom from Diabetes Clinic in Syria between January 2016 and December 2022. ResultsOut of the participants, 152 (22.3 %) successfully achieved all three ABC goals, while 306 (45.0 %) and 183 (26.9 %) achieved two or one goal(s) respectively. The factors influencing the attainment of all three ABC goals revealed a significant association with older age (>50 years), lower body mass index (<25 kg/m2), and lower insulin resistance (Homeostatic Model Assessment of Insulin Resistance < 2.5). Furthermore, patients who successfully achieved all three ABC goals exhibited lower insulin resistance, improved lipid profiles, and higher insulin sensitivity and beta cell function. ConclusionThis study offers new insights into the relationship between insulin resistance/sensitivity and the achievement of ABC goals in the Syrian population with T2D, underscoring the necessity for tailored strategies to enhance comprehensive diabetes management.

The trend of achieving ABC goals in patients with type 2 diabetes between 2010-2014 and 2015–2019

The increasing rate of diabetes and its complications are inevitably increasing the economic burden on healthcare systems. Hence, achieving diabetes ABC goals (HbA1c <7%, Blood pressure <140/90 mmHg, and LDL-C <100 mg/dl) is an essential part of diabetes management. In this retrospective study, 1900 patients with type2 diabetes were recruited. These patients were divided into two 5-year groups; the years 2010–2014 and 2015–2019 and were evaluated based on the achievement of ABC goals. This study showed that in the second 5 year period (2015–2019) there was a significant increase in the achievement of the all three ABC goals compared to 2010–2014. The achievement of LDL<100 mg/dl in patient without cardiovascular disease and LDL<70 mg/dl in patient with cardiovascular disease was better in 2015–2019 compared to that of 2010–2014 (65.4% vs 54.6% Pvalue<0.001). In this study, HbA1C (P value = 0.007), LDL-C (Pvalue <0.001), and coronary heart disease (Pvalue <0.001) were significantly lower in 2015–2019 compared to that of 2010–2014. Duration of diabetes, albuminuria and triglyceride level negatively associated with achievement of all three ABC goals (OR: 0.962, OR: 0.485, OR: 0.994, respectively) (all pvalue <0.05). The proportion of patients who had achieved the ABC goals in the years 2015–2019 was significantly more than that of 2010–2014. However; achievement of goals was generally suboptimal.

315-OR: Diabetes and Dyslipidemia in Young, a Hidden Pandemic—Real-World Multicentric Study from India

Background: In people living with diabetes mellitus, dyslipidemia is one of the significant risk factors for cardiovascular disease. Achieving the ABC clinical targets (HbA1c, blood pressure, and low-density lipoprotein cholesterol) is a well-established method of managing cardiovascular disease related morbidity and mortality among diabetes patients. The management of diabetes disorders is ensured by specialized clinical care provided by diabetes experts, but pernicious risk factors for general cardiovascular health are still largely going unnoticed at the point of care. Purpose: This EHR-based real-world study's objective was to determine which cohorts of people living with diabetes were more likely to experience cardiovascular disease, as determined by the ABC goals. Methods: History of Type 2 diabetes mellitus for at least six months and presenting for routine treatment in one of the 14 centers across the country were included in the study. Data on medical history, comorbidities, diabetes complications, medicines, and laboratory values were gathered using an EMR (Medeva) integrated research proforma. The study started in March 2022 and completed in August 2022. (6 months). Results: Of the 2202 patients with Type 2 Diabetes Mellitus, at the overall level, 3.5% (&amp;lt;35yrs - 1.5%, 35-54 yrs - 2.9% and &amp;gt;54 yrs - 4.2%) of Type 2 Diabetes patients have achieved the ABC targets (HbA1c 7%, BP 130/80 mmHg, and LDL-C 100 mg/dL). On Individual goals, 23.3% (&amp;lt;35yrs - 16.5%, 35-54 yrs - 22.4% and &amp;gt;54 yrs - 24.8%) achieved control on HbA1c, 23.7% (&amp;lt;35yrs- 30.8%, 35-54 yrs - 23.7% and &amp;gt;54 yrs - 22.8%) on BP, and 44.8% (&amp;lt;35yrs - 34.6%, 35-54 yrs - 42.7% and &amp;gt;54 yrs - 47.6%) on LDL-C. Conclusion: The achievement of goals A and C (HbA1C&amp;lt;7% and LDL-C&amp;lt;100 mg/dL) increases by age and subjects with age≥54 years have significantly better control of HbA1c and LDL-C. Younger (&amp;lt;34 Years) patients diagnosed with diabetes are at a much higher risk of cardiovascular disease as compared to older (&amp;gt;54 Years) diabetes patients. Disclosure A.K.Saxena: None. S.S.Dariya: None. S.K.Patra: None. R.Sheohare: None. M.Aslam: None. R.Regulla: None. R.Dantu: None. M.Lakshmanan: None. A.Patil: None. N.K.Singh: None. A.Maheshwari: None. M.Gupta: None. B.Patni: None. D.Kumar: None. V.S.Hiremath: None.

Strong Negative Association of non-HDL Cholesterol Goal Achievement With Incident CKD Among Adults With Diabetes.

The relative importance of the control of different metabolic risk factors for the prevention of chronic kidney disease among patients with diabetes in real life conditions is insufficiently understood. We evaluated the effect of the achievement of glycated hemoglobin A1c (HbA1c), systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDLc) or non-high-density lipoprotein cholesterol (non-HDLc) goals (ABC goals) on the development of incident chronic kidney disease (iCKD) among patients with diabetes. In a nationwide registry of all individuals diagnosed with diabetes assisted by the health system in Colombia, we analyzed the association between baseline or sustained goal achievement and development of iCKD over a 4-year follow-up. iCKD was defined as a new occurrence of an estimated glomerular filtration rate less than 60 mL/min/1.73 m2, hemodialysis, peritoneal dialysis, or kidney transplant. The study included 998 790 adults with diabetes (56% female, mean age 59). There were 125 626 cases of iCKD. After adjustment for multiple confounders, a baseline SBP less than 130 mm Hg (odds ratio [OR] 0.79 [0.78-0.80]) and a baseline HbA1c less than 7.0% (OR 0.86 [0.85-0.87]) were negatively associated with iCKD. Sustained achievement showed stronger negative associations with iCKD than just baseline achievement. Considering each goal separately, sustained non-HDLc less than 130 mg/dL had the strongest negative association with iCKD (OR 0.67 [0.65-0.69]). Patients who maintained the triple ABC goal over the entire follow-up had 32% (29-34) lower odds of developing CKD, 38% (34-42) if they additionally kept a normal body mass index (BMI). Sustained ABC control including a normal BMI was more strongly associated with a lower incidence of CKD in patients of Black race (OR 0.72 vs 0.89; P for interaction = .002). At the country level, sustained achievement of ABC goals and most especially non-HDLc were associated with substantial reductions in iCKD.

The association between advanced glycation end products (AGEs) and ABC (hemoglobin A1C, blood pressure, and low-density lipoprotein cholesterol) control parameters among patients with type 2 diabetes mellitus

BackgroundDiabetes-induced chronic hyperglycemia results in the formation and aggregation of advanced glycation end-products (AGEs), which are products of non-enzymatic glycosylation of lipids or proteins. The development of diabetic complications can be accelerated by AGEs. In the current study, we aimed to explore the relationship between AGEs levels and ABC goals of diabetes control (A: Hemoglobin A1C < 7.0%, B: Blood pressure < 140/90 mmHg, and C: low-density lipoprotein cholesterol [LDL] < 100 mg/dL).MethodsIn the current cross-sectional study, 293 patients with type 2 diabetes mellitus (T2D), were enrolled. Demographic and clinical characteristics of the individuals were collected. AGEs levels were measured using quantitative fluorescence spectroscopy. Finally, the association of AGEs levels with patients' characteristics and ABC goals was assessed.ResultsHigher serum AGEs concentration was detected in older age, smoking patients and those with higher diastolic blood pressure, lower high-density lipoprotein (HDL) level, lower body mass index (BMI) and retinopathy. Moreover, the T2D patients who achieved higher numbers of ABC goals of diabetes were younger age (P-value = 0.003), with lower hemoglobin A1C (P-value = 0.001), fasting blood sugar (P-value = 0.002) diastolic blood pressure (P-value = 0.001), systolic blood pressure (P-value = 0.001), cholesterol (P-value = 0.001), LDL (P-value = 0.001), and AGEs (P-value = 0.023) levels. Diabetic patients with AGEs levels above 73.9% were about 2.2 times more likely to achieve none of ABC treatment goals (95% CI 1.107–3.616).ConclusionOur results revealed the relationship between AGEs and ABC goal achievement, and microvascular diabetic complications, and imply that AGEs measurement may be valuable in the monitoring of diabetic patients' complications and treatment adjustment.

Quality of care and prescription patterns among patients with diabetic kidney disease-a large-scale cohort study from Taiwanese clinics.

AimsTo investigate the quality of care and prescription patterns of patients with diabetic kidney disease (DKD) receiving primary care at local clinics in Taiwan.MethodsA retrospective chart review was conducted in 43 primary care clinics in Taiwan. The patients’ baseline characteristics, laboratory tests, presence of complications and antidiabetic agents prescribed were analyzed.Results7,200 patients with type 2 diabetes mellitus were enrolled. Percentage of HbA1c, blood pressure (BP), and low density lipoprotein cholesterol (LDL-C) goals reached were 52.5% in HbA1c < 7%, 40.9% in BP < 130/80 mmHg and 79.7% in LDL-C < 2.59 mmol/L. 18.3% achieved all three ABC goals. However, patients with DKD had a lower rate of ABC goal attainment and higher rate of complications. Among DKD patients with eGFR ≥ 30 ml/min/1.73 m2 and on monotherapy, metformin was most frequently prescribed. As for dual therapy, the most common combinations were metformin with sulfonylurea and metformin with DPP-4 inhibitors.ConclusionsDiabetes patients in Taiwan receiving primary diabetes care at local clinics had generally satisfactory management performance. However, more aggressive HbA1c, BP, and LDL-C management among DKD patients should be emphasized. Contrary to current recommendations, SGLT-2 inhibitors and GLP-1 receptor agonists as frontline therapy were under-prescribed.

1180-P: Diet Quality and ABC Goals among U.S. Adults with Diabetes: 2013–2018

A healthy diet can help attain hemoglobin HbA1c (A1C) , blood pressure (BP) , and cholesterol goals (ABC goals) in people with diabetes. We examined the association of diet quality with achievement of ABC goals (defined as A1C&amp;lt;8%, BP &amp;lt;140/90 mmHg, non-HDL cholesterol &amp;lt;130 mg/dL, and meeting all three goals) among adults with diabetes. Our analysis included non-pregnant adults aged ≥18 years with a self-reported diabetes diagnosis who had complete data on the 24-hour dietary recalls in the 2013-2018 National Health and Nutrition Examination Surveys. We used the Healthy Eating Index-2015 (HEI-2015) to measure diet quality. Overall, the median HEI-2015 among adults with diabetes was 51.1 points; a score larger than the median was positively associated with achievement of the A1C goal (Figure) . After adjusting for age, sex, race/ethnicity, education, marital status, health status, health insurance status, and smoking status using logistic regressions, we found that an interquartile increase in HEI-2015 (from 43.0 to 60.2 points) was significantly associated with 4.5 percentage points larger probability (74.3% compared with 78.8%, p=0.02) of meeting the A1C goal. No significant associations were found between HEI-2015 and achievement of BP, cholesterol, or combined ABC goals. Public health efforts to improve dietary quality among people with diabetes may help to increase the proportion of individuals with diabetes who achieve A1C goals. Disclosure K.R. Siegel: None. K.M. Bullard: None. D.B. Rolka: None.

Quality of care in type 2 diabetes in Iran; a cross-sectional study using patient-level data

BackgroundAppropriate service delivery, access to high quality of cares and optimal management of type 2 diabetes mellitus (T2DM) can decrease the risk of micro and macro vascular complications and mortality. Therefore, monitoring the quality of diabetes care, including keeping glycemic levels at an optimal level, is crucial. The aim of this study was to evaluate processes and outcome-related quality of care indicators, in T2DM using retrospective patient-level data from 2013 to 2017 in 15 Tertiary Diabetes Care Centers in Iran.MethodA retrospective observational study was conducted among 1985 T2DM patients at public, semipublic and private diabetes centers. Annual tests for HbA1c, serum lipid (LDL), and screening for nephropathy were used to evaluate process-related indicators; and intermediate biomedical markers including HbA1c, blood pressure (BP), and LDL cholesterol, were used to assess outcome-related indicators.ResultsData were extracted from 15 diabetes centers in five provinces in Iran. 62.7% of the patients were female, and the mean duration of diabetes in the patients was 14.7 years. Evaluation of process-related indicators showed that only 9% of patients took the HbA1c test. The percentage of the patients without annual low-density lipoprotein (LDL) test decreased from 13% in 2013 to 7% in 2017. The results of achieving to all indicators concurrently (ABC care) showed that less than 2% of the patients met the criteria of optimal process-related quality indicators.The mean percentage of the patients with HbA1c under 7%, blood pressure (BP) less than 130/80 mmHg, and LDL less than 100 mg/dl in the selected provinces were 32.4, 55, and 71 respectively. However, the average of total achievement in ABC goals was 14.2%.ConclusionOur findings showed that the management of T2DM in all selected provinces was far from the optimal control in both processes and outcome-related indicators and therefore needs serious consideration and improvement.

Poorer Attainment of Hemoglobin A1C, Blood Pressure and LDL-Cholesterol Goals among Younger Adults with Type 2 Diabetes

Concurrent attainment of glycated haemoglobin A1C, blood pressure, and LDL-cholesterol goals, or collectively known as the ‘ABC’ goals, help prevent cardiovascular complications in patients with type 2 diabetes (T2D). We aimed to determine the proportion of T2D patients who achieved all three ABC goals in Malaysia’s public health clinics. We also determined the association between age groups with the attainment of all the ABC goals. A cross-sectional analysis of the baseline findings from a retrospective open cohort study between 2013 and 2017 in Negeri Sembilan, Malaysia was conducted. The data was extracted from the National Diabetes Registry. The primary outcome was the proportion of patients who attained all three ABC goals. The exposure of interest was patients’ age groups, namely 18-44, 45-59 and ≥ 60 years. Multivariate logistic regression analysis was used to adjust demographics factors, comorbidities, complications and treatment profiles. Among 17,592 patients, the mean age was 59.1 years, with 56.3% females and 64.9% Malays. Overall, 4.5% (95% CI: 4.2-4.8) of the patients attained all the ABC goals. Compared to older adults aged ≥ 60 years, patients aged 18-44 and 45-59 years had adjusted odds ratios of 0.50 and 0.72, respectively, to achieve all the ABC goals. Ethnicity, body mass index, diabetes treatment modality, lipid-lowering agent and polypharmacy were independent factors associated with the outcome. In summary, achieving all the ABC goals in T2D patients is challenging, especially among younger adults. Our findings suggest that more targeted interventions should be directed towards this high-risk subpopulation.

Control of Glucose, Blood Pressure, and Cholesterol among Adults with Diabetes: The Brazilian National Health Survey.

ABC (glucose, blood pressure and LDL-cholesterol) goals are basic standards of diabetes care. We aimed to assess ABC control and related factors in a representative sample of Brazilian adults with diabetes. We analyzed 465 adults with known diabetes in the Brazilian National Health Survey. The targets used were <7% for glycated hemoglobin (A1C); <140/90 mmHg for blood pressure; and <100 mg/dL for LDL-C, with stricter targets for the latter two for those with high cardiovascular (CVD) risk. Individual goals were attained by 46% (95% CI, 40.3–51.6%) for A1C, 51.4% (95% CI, 45.7–57.1%) for blood pressure, and 40% (95% CI, 34.5–45.6%) for LDL-C. The achievement of all three goals was attained by 12.5% (95% CI, 8.9–16.2%). Those with high CVD risk attained blood pressure and LDL-C goals less frequently. A1C control improved with increasing age and worsened with greater duration of diabetes. Achievement of at least two ABC goals decreased with increasing BMI and greater duration of diabetes. In sum, about half of those with known diabetes achieved each ABC goal and only a small fraction achieved all three goals. Better access and adherence to treatment and strategies to personalize goals according to specific priorities are of the essence.

839-P: Impact of Culturally Specific Care Teams on Mitigation of Racial Disparities in Diabetes Care: A Five-Year EHR-Based Study

Cultural and language barriers are known to reduce the likelihood of Asian-American patients (AA) with diabetes achieving recommended goals for HbA1c, blood pressure, and LDL, known as ‘ABCs of DM.’ Our previous study of an integrated Asian clinic for AA (AAC) at Joslin Diabetes Center, showed more AA patients achieving ABC goals 1-year after their initial visit, than whites in the Adult Diabetes clinic (WDC). AAC staff, including MDs, dietitians, educators, and patient coordinators, are all multi-lingual AAs who offer culturally-tailored management approaches. In a 5-year follow-up study between 2014 to 2019, we examined the clinical performance of new patients with T2D, comparing the following groups: AAC (n=166), AA in Adult Diabetes Clinic (ADC) (n=186), and WDC (n=2993). Compared to WDC and ADC, AAC patients were older (P=0.06), had lower BMI (P&amp;lt;0.001), lower education levels (P&amp;lt;0.001), more likely to be on Medicare (P&amp;lt;0.001), more likely to be non-native English speakers, and had significantly more educator sessions (P&amp;lt;0.001). At the initial visit, AAC patients had similar metabolic profiles as ADC and WDC (P=0.50). At the end of 5 years, 32.0% of AAC patients achieved the ABC goals, compared to 23.7% in WDC and 34.6% in ADC. Across all patients, the odds of meeting ABC goals are significantly higher (P&amp;lt;0.01) by having English as a primary language (OR:1.51; 95% CI: 1.19 - 1.26) and not being on Medicare (OR:1.24; 95% CI: 1.09 - 1.41). After adjusting for these factors, over 5-years of follow-up, the odds of AAC patients meeting ABC goals are similar to WDC patients (OR:0.58; 95% CI:0.25- 2.31, P=0.11) and better than ADC patients (OR:1.30, 95% CI:0.98- 3.22; P=0.06). Despite the financial, language, and educational disadvantages, AAC patients have achieved similar ABC targets as WDC and ADC patients. These findings suggest that culturally-specific care for AA can mitigate healthcare disparity in T2D management and can be maintained over prolonged periods of time. Disclosure A. Adam: None. K. Lau: None. H. Shah: None. M. Yu: None. G. L. King: Consultant; Self; Agios, Inc., Medtronic, Other Relationship; Self; Janssen Pharmaceuticals, Inc.

Association of ABC (HbA1c, blood pressure and LDL-cholesterol) goal achievement with visit-to-visit ABC variability and postprandial dysmetabolism in type 2 diabetic patients.

Although roles of ABC (HbA1c, blood pressure [BP] and LDL-cholesterol) goal attainment on CVD risk outcomes have been well established, it is less studied whether ABC goal attainment associates with ABC variability, non-traditional risk factors. Intrapersonal mean levels and standard deviation (SD) of HbA1c, BP and LDL-cholesterol, fasting and post-breakfast plasma glucose (PG) and serum triglyceride (TG) during 12 months were calculated in 168 type 2 diabetes patients (aged 62.3 years, 53.6% men). Associations of ABC goal attainment with non-traditional glycemic, BP and lipid risk factors were analyzed. Among 168 patients, 92 (54.8%), 91 (54.2%) and 111 (66.1%) patients achieved HbA1C, BP and cholesterol goal, respectively, and 47 (28.0 %), 45 (26.8 %), 63 (37.5 %) and 13 (7.7 %) achieved triplegoal, dual-goal, single-goal and no-goal, respectively. Achieving more ABC goals was associated with stepwise decreases in mean levels and SD of fasting and post-breakfast PG, and HbA1c. It was also associated with stepwise decreases in mean levels and SD of fasting and post-breakfast TG, and LDL-cholesterol. Further, achieving more ABC goals was associated with stepwise decreases in brachial pulse pressure and mean levels and SD of systolic BP. ABC goal achievement was associated with a broad range of non-traditional glycemic, BP and lipid risk factors in type 2 diabetic patients. Reaching more ABC treatment targets may be important for reductions in long-term ABC variability and postprandial dysmetabolism.

1535-P: Associations between Eating Patterns and Meeting ABC Goals among U.S. Adults with Diagnosed Diabetes

Nutrition is important for individuals with diabetes (DM), as healthful eating patterns may help to attain individual glycemic, blood pressure (BP), and lipid goals (ABC goals) and to delay or prevent complications. Using data from 2,805 non-pregnant adults aged ≥20 years with self-reported diagnosed DM and complete data on diet (one day of 24-hour recall), A1c, BP, and non-HDL cholesterol in the National Health and Nutrition Examination Surveys 2007-2016, we examined associations between five American Diabetes Association-recommended eating patterns and meeting ABC goals. Adjusting for age, sex, race/ethnicity and daily calorie intake, we used logistic regression to calculate the proportion of individuals meeting ABC goals (defined as A1c&amp;lt;8%, BP &amp;lt;140/90 mmHg, non-HDL cholesterol &amp;lt;130 mg/dL, and meeting all three), as well as prevalence ratios, by adherence to each eating pattern. Overall, following a Mediterranean-style diet or a low-fat diet was significantly associated with meeting A1c. Following a vegetarian diet was significantly associated with meeting BP goal. Following a Mediterranean-style diet was also significantly associated with meeting all ABC goals. These results suggest that improved nutrition among adults with DM may help with meeting treatment goals, and that overall healthy eating patterns may be as important for meeting goals than diets that focus on a single macronutrient. Disclosure K.R. Siegel: None. K.M. Bullard: None. S. Saydah: None. C. Mercado: None. M.K. Ali: Research Support; Self; Merck &amp; Co., Inc. A.L. Albright: None. G. Imperatore: None.

Inadequate achievement of ABC goals (HbA1c, blood pressure, LDL-C) among patients with type 2 diabetes in an Iranian population, 2012–2017

AimsThis study was designed to evaluate the meeting of ABC goals in patients with type 2 diabetes. The ABC goals were defined as meeting the HbA1c <7%, systolic blood pressure <130 mmHg and diastolic blood pressure <80 mmHg, and LDL-C <100 mg/dL. We also determined the associated factors with meeting the ABC goals, as well as the effectiveness of statin therapy. MethodsWe designed a cross-sectional study of 2008 type 2 diabetes patients attending the diabetes clinics of Valiasr Hospital of Imam Khomeini Hospital Complex. Meeting ABC goals and their associated factors were analyzed from the registered data. ResultsAt the end of the year 2014, 61.3% of patients met the HbA1c goal, which increased to 77.8% in 2017. Blood pressure of 79.5% of patients met the ADA recommendations by the end of the year 2014, reaching 86.6% in 2017. Moreover, 84.5% and 93.8% could reach the LDL-C goal in 2014 and 2017, respectively. The proportion for the patients meeting all three ABC goals were 23.2% and 42.1% in 2014 and 2017, respectively. ConclusionsThe level of achievement of ABC goals in Iran is lower than expected and it requires a lot of programming effort and follow-up. As patients are followed over the years, controlling ABC becomes much more favorable.

Comparison of primary versus secondary prevention of cardiovascular disease in patients with type2 diabetes: Focus on achievement of ABC goals

BackgroundPrimary and secondary prevention of cardiovascular disease is of utmost importance in the management of patients with diabetes. ObjectivesWe studied a group of Iranian patients with type2 diabetes to provide an overview of the current status of secondary prevention of cardiovascular disease in the Middle East. MethodsThis is a cross-sectional study of 2029 Patients with type2 diabetes including 323 patients with coronary artery disease (CAD) were recruited. Achievement of goals in HbA1c (A), blood pressure (B) and LDL-cholesterol(C) was assessed. ResultsThe study showed 25.3% of CAD positive patients achieved HbA1c <7% compared to 30% in CAD negative patients. The achievement of blood pressure ≤140/90 mmHg was 53.2% and 52.8% in CAD positive and CAD negative patients respectively. There was no difference in the achievement of all three ABC goals between the two groups (p = 0.733). After logistic regression analysis, history of hypertension had the highest odds ratio for CAD. ConclusionAlthough ABC control has an important impact on the prevention of cardiovascular outcomes, the ideal goal needs further efforts to be achieved.

Effectiveness of standardized nursing care plans to achieve A1C, blood pressure, and LDL-C goals among people with poorly controlled type 2 diabetes mellitus at baseline: four-year follow-up study

BackgroundNo studies that have measured the role of nursing care plans in patients with poorly controlled type 2 diabetes mellitus. Our objectives were firstly, to evaluate the effectiveness of implementing Standardized languages in Nursing Care Plans (SNCP) for improving A1C, blood pressure and low density lipoprotein cholesterol (ABC goals) in patients with poorly controlled type 2 diabetes mellitus at baseline (A1C ≥7%, blood pressure ≥ 130/80 mmHg, and low-density lipoprotein cholesterol≥100 mg/dl) compared with Usual Nursing Care (UNC). Secondly, to evaluate the factors associated with these goals.MethodsA four-year prospective follow-up study among outpatients with type 2 diabetes mellitus: We analyzed outpatients of 31 primary health centers (Madrid, Spain), with at least two A1C values (at baseline and at the end of the study) who did not meet their ABC goals at baseline. A total of 1916 had A1C ≥7% (881 UNC versus 1035 SNCP). Two thousand four hundred seventy-one had systolic blood pressure ≥ 130 mmHg (1204 UNC versus 1267 SNCP). One thousand one hundred seventy had diastolic blood pressure ≥ 80 mmHg (618 UNC versus 552 SNCP); and 2473 had low-density lipoprotein cholesterol ≥100 mg/dl (1257 UNC versus 1216 SNCP). Data were collected from computerized clinical records; SNCP were identified using NANDA and NIC taxonomies.ResultsMore patients cared for using SNCP achieved in blood pressure goals compared with patients who received UNC (systolic blood pressure: 29.4% versus 28.7%, p = 0.699; diastolic blood pressure: 58.3% versus 53.2%, p = 0.08), but the differences did not reach statistical significance. For A1C and low-density lipoprotein cholesterol goals, there were no significant differences between the groups. Coronary artery disease was a significant predictor of blood pressure and low-density lipoprotein cholesterol goals.ConclusionsIn patients with poorly controlled type 2 diabetes mellitus, there is not enough evidence to support the use of SNCP instead of with UNC with the aim of helping patients to achieve their ABC goals. However, the use of SNCP is associated with a clear trend of a achievement of diastolic blood pressure goals.

Room for Improvement: The HIV-Diabetes Care Continuum Over 15 Years in the Women's Interagency HIV Study.

BackgroundGains in life expectancy through optimal control of HIV infection with antiretroviral therapy (ART) may be threatened if other comorbidities, such as diabetes, are not optimally managed.MethodsWe analyzed cross-sectional data of the Women’s Interagency HIV Study (WIHS) from 2001, 2006, and 2015. We estimated the proportions of HIV-positive and HIV-negative women with diabetes who were engaged in care and achieved treatment goals (hemoglobin A1c [A1c] <7.0%, blood pressure [BP] <140/90 mmHg, low-density lipoprotein [LDL] cholesterol <100 mg/dL, not smoking) and viral suppression. Repeated-measures models were used to estimate the adjusted prevalence of achieving each diabetes treatment goal at each time point, by HIV status.ResultsWe included 486 HIV-positive and 258 HIV-negative women with diabetes. In 2001, 91.8% visited a health care provider, 60.7% achieved the A1c target, 70.5% achieved the BP target, 38.5% achieved the LDL cholesterol target, 49.2% were nonsmokers, 23.3% achieved combined ABC targets (A1c, BP, and cholesterol), and 10.9% met combined ABC targets and did not smoke. There were no differences by HIV status, and patterns were similar in 2006 and 2015. Among HIV-positive women, viral suppression increased from 41% in 2001 to 87% in 2015 compared with 8% and 13% achieving the ABC goals and not smoking. Viral suppression was not associated with achievement of diabetes care goals.ConclusionsSuccessful management of HIV is outpacing that of diabetes. Future studies are needed to identify factors associated with gaps in the HIV–diabetes care continuum and design interventions to better integrate effective diabetes management into HIV care.

A1c, blood pressure and cholesterol goal achievement in patients of Type 2 diabetes

Background: Management of Type 2 diabetes (T2D) requires comprehensive control of three metabolic parameters (A1c, blood pressure, and cholesterol [ABC]), popularly known as the ABCs of diabetes. We studied the prevalence of patients reaching the ABC goals in Indian diabetes patients. Materials and Methods: The study was conducted at two tertiary level care centers in India. All patients with a diagnosis of T2D (aged 30-75 years, 1 year duration, received a prescription for an oral hypoglycemic agent, or insulin) seen between January and June 2014 were included in this cross-sectional, observational study. Patients with a major illness, recent surgery or diabetic ketoacidosis, use of glucocorticoids, posttransplant, and gestational diabetes were excluded from the study. Descriptive statistics were used for describing the data, and Chi-square test was used for analyzing the frequency distribution. Results: The study participants (531 male:469 female) had a mean age of 46.9 ± 12.3 year, body mass index of 28.2 ± 5.5 kg/m 2 , and an A1c of 8.7 ± 1.9%. A total of 90 patients (9%) achieved the 3 part ABC goal. The 2 point goal of adequate control of blood pressure (BP) and lipids is achieved in the majority of the patients (46.5%). The individual goals of all the three constituents were achieved by 201 patients for glucose, 942 patients for BP and 509 patients for the low-density lipoprotein cholesterol. Conclusion: Our data showed that only 9% of patients achieved the ABC goals. Our study highlights the urgent unmet need, to improve the quality of diabetes care in our country.

Association of ABC (HbA1c, blood pressure, LDL-cholesterol) goal attainment with depression and health-related quality of life among adults with type 2 diabetes

AimsTo determine the relationship between ABC goal attainment, depression, and health-related quality of life (HRQoL) among a national sample of patients with type 2 diabetes (T2DM). MethodsA retrospective, cross-sectional analysis was performed examining 808 non-pregnant patients ≥20years old with T2DM from the National Health and Nutrition Examination Survey (NHANES) 2007–2012. ABC goals were defined as HbA1c<7%, BP<130/80mm Hg, and LDL-C<100mg/dL. Patient characteristics associated with ABC goal attainment were examined. ResultsOverall, 23.7% of participants achieved simultaneous ABC goals. Severe depression was significantly associated with lower rates of ABC goal attainment compared to those with no depression (5.0% vs. 25.4%, p=0.048). ABC goal attainment rates were lower among females, Hispanic and non-Hispanic black minority groups, and patients with a duration of diabetes over five years, while increased visits with health care professionals were significantly associated with meeting all three ABC goals for patients with T2DM. ConclusionsThe relationship between simultaneous ABC goal attainment, depression and HRQoL is complex. Patients with T2DM unable to meet ABC goals may benefit from increased contact with health care professionals.