Composite Cardiovascular Risk Factor Target Achievement and its Predictors in US Adults with Diabetes: The Diabetes Collaborative Registry.

BACKGROUND AND OBJECTIVE: Patients with diabetes mellitus (DM) at composite atherosclerotic cardiovascular disease (ASCVD) risk factor (RF) targets have >50% lower ASCVD risks. Limited "real world" data exists on how often such targets are reached. We studied multiple RF target attainment for ASCVD prevention and its predictors in a contemporary DM registry.

METHODS: In the US Diabetes Collaborative Registry we identified patients at target for HbA1c (<7.0% or <8.0% if with ASCVD), LDL-C (<100 or <70 mg/dl if ASCVD), blood pressure (<140/90 mmHg and <130/80 mmHg as an alternate), and nonsmoking status by sex, race, and history of ASCVD. Multiple logistic regression examined predictors of target attainment.

RESULTS: In 74,393 DM persons with available data (mean age 69.0 years, 41.0% female), overall target attainment for HbA1c, BP, LDL-C and non-smoking status was 73.6%, 69.0% (40.3% if BP<130/80 mmHg), 48.6% and 85.2%, respectively. Only 21.6% (13.0% with BP<130/80 mmHg) were at target for all four measures, being greater in men (23.6%) versus women (18.6%) and in whites (22.5%) compared to African-Americans (14.7%) and other races (20.8%) (p<0.01). 62.4% were on a moderate/high intensity statin. Age (>65: odds ratio, OR=1.9 [1.7-2.0] or 55-64: OR=1.3 [1.2-1.4] vs. <55 years), male sex (OR=1.3 [1.3-1.4]), white race (OR=1.4 [1.3-1.5]), middle or high income (OR's 1.1 [1.1-1.2] and 1.4 [1.4-1.5], respectively) were associated, and depression (OR=0.9 [0.8-1.0]) was inversely associated with meeting all 4 targets (all p=0.01 to p<0.001).

CONCLUSIONS: In our US registry of DM patients, only 1 in 5 are achieving comprehensive RF control. Multifactorial interventions will be necessary to optimize ASCVD RF control. This article is protected by copyright. All rights reserved.