Triple-Goal Achievement Reduces Risk for Complications in Type 2 Diabetes

Achieving triple treatment targets can help lower risk of developing long-term health complications in individuals with type 2 diabetes, according to a study published in Diabetes Research and Clinical Practice.

This large scale, retrospective study sought to compare long-term health outcomes of individuals with type 2 diabetes, specifically assessing the risk for microvascular and macrovascular complication events, as well as mortality.

The study identified a cohort of 53,120 patients with type 2 diabetes from the Veterans Affairs electronic medical records who each received a propensity score weight, balancing medical history at baseline and demographic characteristics for improved comparability.

The cohort was evaluated to compare the long-term effect of achieving 3 treatment goals (defined as glycated hemoglobin <7%, low-density lipoprotein cholesterol <100 mg/dl, and blood pressure <140/90 mm Hg) and was divided into 4 groups: triple-goal achievers (25.43%), dual-goal achievers (41.36%), single-goal achievers (26.37%), and no-goal achievers (6.84%). The composite results showed a significant positive association between a higher number of goal achievement and better health outcomes, suggesting that management of glycated hemoglobin, low-density lipoprotein cholesterol, and blood pressure reduces the risk for complication events or death in type 2 diabetes.

Compared with the dual-achievement group, the triple-goal achievers overall showed lower risk for macrovascular complications, mortality, and microvascular complications. Upon analysis, however, the triple-goal group compared with the dual-goal groups that included the achievement of low-density lipoprotein cholesterol did not show a significant reduction in risk for complications or death. This suggests that management of low-density lipoprotein cholesterol is the only treatment goal that consistently reduces potential complication outcomes.

Limitations included restricted or unavailable information about the severity and duration of diabetes, prescribed medications and dosage, adherence to medications, and whether patients received health care services outside of the Veterans Affairs system. Another disadvantage was a mostly male cohort, limiting the generalizability of the study applied to a larger female population.

The study sought to clarify the association of the number of treatment goals achieved and the benefit of long-term health outcomes. By identifying the goal of low-density lipoprotein cholesterol as the most significant influence on long-term health, the clinical benefits of managing low-density lipoprotein cholesterol should be considered in the treatment of those with type 2 diabetes.

Reference

Shi Q, Liu S, Krousel-Wood M, Shao H, Fonseca V, Shi L. Long-term outcomes associated with triple-goal achievement in patients with type 2 diabetes mellitus (T2DM). Diabetes Res Clin Pract. 2018;140:45-54.