PMID- 34675042
OWN - NLM
STAT- MEDLINE
DCOM- 20211230
LR  - 20230807
IS  - 2052-4897 (Electronic)
IS  - 2052-4897 (Linking)
VI  - 9
IP  - 1
DP  - 2021 Oct
TI  - Optimizing treatment goals for long-term health outcomes among patients with type 
      2 diabetes mellitus.
LID - 10.1136/bmjdrc-2021-002396 [doi]
LID - e002396
AB  - INTRODUCTION: Considerable confusions on treatment target have resulted from 
      recent changes in guidelines. Evidence in medical guidelines came from clinical 
      trials with highly selected patients, whereas treatment goals may differ in some 
      subgroups. This study aimed to assess optimal treatment goals (A1C, blood 
      pressure, low-density lipoprotein cholesterol (LDL-C)) for patients with type 2 
      diabetes mellitus (T2DM), which lead to optimal health outcomes by different 
      treatment strategies. RESEARCH DESIGN AND METHODS: A retrospective longitudinal 
      study was conducted for veterans with T2DM by using US Veterans Affairs 
      Administrative Database (2005-2015). Medical records were prepared for repeated 
      evaluation performed at 6-month intervals and multivariate longitudinal 
      regression was used to estimate the risk of microvascular and macrovascular 
      complication events. Second-degree polynomial and splines were applied to 
      identify the optimal goals in their associations with lowest risk of clinical 
      outcomes, controlling for demographic characteristics, medical history, and 
      medications. RESULTS: A total of 124 651 patients with T2DM were selected, with 
      mean of 6.72 follow-up years. In the general population, to achieve the lowest 
      risk of microvascular and macrovascular complication, the optimal goals were 
      A1C=6.81%, LDL-C=109.10 mg/dL; and A1C=6.76%, LDL-C=111.65 mg/dL, systolic blood 
      pressure (SBP)=130.60 mmHg, respectively. The optimal goals differed between age 
      and racial subgroups. Lower SBP for younger patients and lower LDL-C for black 
      patients were associated with better health outcomes. CONCLUSIONS: Optimal 
      treatment goals were identified and multi-faceted treatment strategies targeting 
      hyperglycemia and hyperlipidemia and hypertension may improve health outcome in 
      veterans with T2DM. In addition to guidelines' recommended goals, health systems 
      may examine their own large diverse patients with T2DM for better quality of 
      care.
CI  - (c) Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Shi, Qian
AU  - Shi Q
AD  - Department of Health Policy and Management, Tulane University School of Public 
      Health and Tropical Medicine, New Orleans, Louisiana, USA.
FAU - Lin, Yilu
AU  - Lin Y
AUID- ORCID: 0000-0001-7040-4287
AD  - Department of Health Policy and Management, Tulane University School of Public 
      Health and Tropical Medicine, New Orleans, Louisiana, USA.
FAU - Fonseca, Vivian A
AU  - Fonseca VA
AD  - Department of Medicine and Pharmacology, Tulane University School of Medicine, 
      New Orleans, Louisiana, USA.
FAU - Shi, Lizheng
AU  - Shi L
AD  - Department of Health Policy and Management, Tulane University School of Public 
      Health and Tropical Medicine, New Orleans, Louisiana, USA lshi1@tulane.edu.
LA  - eng
GR  - U54 GM104940/GM/NIGMS NIH HHS/United States
PT  - Journal Article
PL  - England
TA  - BMJ Open Diabetes Res Care
JT  - BMJ open diabetes research & care
JID - 101641391
RN  - 0 (Glycated Hemoglobin A)
SB  - IM
MH  - *Diabetes Mellitus, Type 2/drug therapy/epidemiology
MH  - Glycated Hemoglobin/analysis
MH  - Goals
MH  - Humans
MH  - Longitudinal Studies
MH  - Outcome Assessment, Health Care
MH  - Retrospective Studies
PMC - PMC8532550
OTO - NOTNLM
OT  - diabetes complications
OT  - diabetes mellitus
OT  - disease management
OT  - type 2
COIS- Competing interests: None declared.
EDAT- 2021/10/23 06:00
MHDA- 2021/12/31 06:00
PMCR- 2021/10/21
CRDT- 2021/10/22 05:46
PHST- 2021/05/19 00:00 [received]
PHST- 2021/10/03 00:00 [accepted]
PHST- 2021/10/22 05:46 [entrez]
PHST- 2021/10/23 06:00 [pubmed]
PHST- 2021/12/31 06:00 [medline]
PHST- 2021/10/21 00:00 [pmc-release]
AID - 9/1/e002396 [pii]
AID - bmjdrc-2021-002396 [pii]
AID - 10.1136/bmjdrc-2021-002396 [doi]
PST - ppublish
SO  - BMJ Open Diabetes Res Care. 2021 Oct;9(1):e002396. doi: 
      10.1136/bmjdrc-2021-002396.