Prioritizing Early Glycemic and Blood Pressure Control in Type 2 Diabetes: An Attributional Modeling Study

Introduction: To support pragmatic prioritization of early management targets in primary care using attributional modeling of mortality determinants in type 2 diabetes from the Swedish National Diabetes Register (NDR), and to test the robustness of the “2S2H” principle (Six Months, Sixty Percent, Hypertension, HbA1c) across simulated multi-region cohorts. Methods: An attributional modeling framework was used to partition preventable mortality across major modifiable risk factors using NDR data (n = 271,174). Temporal analyses assessed the impact of achieving early dual control of glycemia and blood pressure. Robustness was evaluated using simulated multi-regional cohorts. Results: HbA1c and blood pressure jointly accounted for approximately 55–60% (95% CI 52–63%) of preventable mortality, with HbA1c contributing ~30% (27–33%) and blood pressure ~25% (22–28%). Attributional rankings were stable across simulated regions (maximum deviation <10%). Achieving dual control of HbA1c (<7.0%) and blood pressure (<140/90 mmHg) within six months captured most of the mortality benefit observed over 24 months. Conclusion: Attributional decomposition suggests that early dual prioritization of glycemic and blood pressure control may help clinicians focus on high-impact targets when time, resources, or adherence are limited, supporting informed prioritization in primary care and policy settings.