What is the clinical evidence from this study?

Study design: Observational. Population: Diabetes and hypertension (n=1372). Intervention: Medical care at urban academic medical centers. Primary outcome: Combined ADA goal for blood pressure, LDL cholesterol, and HbA1c.

April 1, 2002Diabetes Care234 citationsOpen Access

Control of Cardiovascular Risk Factors in Patients With Diabetes and Hypertension at Urban Academic Medical Centers

SMSamy I. McFarlaneGeneral / Preventive / Lipids SJScott J. JacoberUniversity of North Carolina at Chapel Hill NWNathaniel WinerCedars-Sinai Medical Center

Key Result

Only 3.2% of urban clinic patients with diabetes and hypertension met the combined ADA treatment goals for blood pressure, LDL cholesterol, and HbA1c.

Study Design

Type

Observational (n=1,372)

Multicenter

Yes

Structured PICO

Population

1,372 adult patients with diabetes and hypertension receiving medical care at two urban medical centers.

Outcome

Proportion of patients meeting ADA treatment goals for blood pressure (<130/85 mmHg), LDL cholesterol (<100 mg/dl), HbA1c (<7%), and antiplatelet therapysurrogate

A very small minority of patients with diabetes and hypertension at urban academic medical centers achieve optimal control of cardiovascular risk factors, highlighting significant gaps in guideline implementation.

Abstract

OBJECTIVE: There are national mandates to reduce blood pressure (BP) to <130/85 mmHg, LDL cholesterol to <100 mg/dl, and HbA(1c) to <7% and to institute aspirin therapy in patients with diabetes. The objective of this study was to determine the proportion of patients in urban institutions with diabetes and hypertension who meet these treatment goals. RESEARCH DESIGN AND METHODS: Using American Diabetes Association (ADA) guidelines, we evaluated the control of cardiovascular disease (CVD) risk factors in 1,372 patients receiving medical care at two major urban medical centers in Brooklyn and Detroit. Information was extracted from charts of outpatient clinics. RESULTS: Of 1,372 active clinic patients with diabetes and hypertension, 1,247 (90.9%) had type 2 diabetes, and 26.7% met the target blood pressure of 130/85 mmHg. A total of 35.5% met the goal LDL cholesterol level of <100 mg/dl, 26.7% had an HbA(1c) <7%, and 45.6% were on antiplatelet therapy. Only 3.2% of patients met the combined ADA goal for BP, LDL cholesterol, and HbA(1c). CONCLUSIONS: Optimal control of CVD risk factors in adults with diabetes was achieved only in a minority of patients. Results reflect the inherent difficulties in achieving these complex guidelines in our present health care systems.

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