Abstract 3127: The Impact of Glycemic Control on the Risk of Macrovascular Complications among Primary Care Patients with Type 2 Diabetes
Background: The role of aggressive diabetic management in the prevention of macrovascular complications remains unclear. This study of longitudinal electronic medical records (EMR) examines the risk of macrovascular complications based on the level of diabetic control in a community based primary care population.
Methods: A total of 18,747 adult patients followed in 6 primary care practices using an EMR encompassing longitudinal office care and hospitalizations from 1998 to 2007 were selected. Those with known pre-existing cardiovascular disease were excluded. Type 2 diabetic patients were identified and grouped according to their degree of diabetic control using the average of their HgbA1c values. Cox models adjusted for age, sex, race, hypertension, and hyperlipidemia were developed analyzing time to first macrovascular complication by degree of overall glycemic control.
Results: A total of 2066 diabetics were identified and followed for a median of 5.4 years. The mean age was 53 years, 56% were female, and 46% were African-American. The proportion of patients with macrovascular complications was lowest for the HA1c 6 – 6.9% group (6.9%, 47 of 683), and increased in those with HA1c < 6% (8.4%, 12 of 143), HA1c 7– 8.9% (12.5%, 94 of 755), and HA1c ≥ 9% (12.0%, 58 of 485). In the Cox model, adjusting for age, sex, race, hyperlipidemia, and blood pressure; and when compared to those with HA1c < 7%, those under intermediate (HA1c 7– 8.9%) and poor control (HA1c ≥ 9%) demonstrated a significant increase in risk (see table⇓). Increasing age and severe hypertension also contributed significantly to the model.
Conclusion: In this primary care population without pre-existing CAD, intermediate (HA1c 7– 8.9%) and poor (HA1c ≥ 9%) glycemic control was associated with significant and progressively increasing risk of macrovascular complications. There was, however, no discernable advantage to tight glycemic control (HA1c < 6.0%) in reducing this risk in this population.