The risk factors of glycemic control, blood pressure control, lipid control in Chinese patients with newly diagnosed type 2 diabetes _ A nationwide prospective cohort study

Abstract

Nationwide data on glycemic control, blood pressure (BP) control and lipid control in patients with newly diagnosed type 2 diabetes were vacant in China. The aim of this study was to assess the clinical outcomes for these patients. This is an observational prospective cohort study with 12 months of follow up. Patients with a diagnosis of type 2 diabetes less than 6 months were enrolled. Hemoglobin A1c (HbA1c) levels, BP levels and lipid levels were collected at baseline and the follow-ups. This study was registered at www.clinicaltrials.gov (NCT01525693). A total of 5770 participants from 79 hospitals across six geographic regions of China were recruited. After 12 months of treatment, 68.5% of these patients achieved HbA1c <7.0%; 83.7% reached BP <140/90 mmHg; 48.2% met low density lipoprotein cholesterol (LDL-c) <2.6 mmol/L; and 29.5% of patients reached the combined three therapeutic targets. Compared to those patients with baseline HbA1c <7.0%, patients with baseline HbA1c ≥7.0% had higher failure rate to reach glycemic control (relative risk (RR) = 2.04, p < 0.001), BP control (RR = 1.21, p < 0.001) and LDL-c control (RR = 1.11, p < 0.001). Obese patients had higher possibilities of failure in glucose control (RR = 1.05, p = 0.004), BP control (RR = 1.62, p < 0.001) and lipid control (RR = 1.09, p = 0.001) than patients with normal weight. The active smokers were more likely to fail in glycemic control than non-smokers (RR = 1.06, p = 0.002), and patients with physical activities were less likely to fail in lipid control than patients without exercises (RR = 0.93, p = 0.008). This study outlined the burdens of glycemic control, blood pressure control, lipid control in newly diagnosed type 2 diabetic patients in China, identified gaps in the quality of care and risk-factor control and revealed the factors influencing these gaps.

Conflict of interest statement

Linong Ji has received fees for lecture presentations from AstraZeneca, Merck, Novartis, Lilly, Roche, Sanofi-Aventis and Takeda. Linong Ji has received consulting fees from companies including AstraZeneca, Merck, Novartis, Lilly, Roche, Sanofi-Aventis and Takeda. Linong Ji has received grants/research support from AstraZeneca, Bristol-Myers Squibb, Merck, Novartis, and Sanofi-Aventis. There are no other disclosures for other authors.

Figures

Figure 1

Proportion of patients reaching the target of HbA1c A) Proportion of patients reaching the target of HbA1c <7.0% at baseline and during the 12 months of follow-ups (p < 0.05), proportion of patients reaching the intensive target of HbA1c <6.5% at baseline and during the 12 months of follow-ups (p < 0.05). (B) Proportion of patients reaching the target of BP <140/90 mmHg at baseline and during the 12 months of follow-ups in total patients (p < 0.05 for trend) and in patients with hypertension (HTN) (p < 0.05 for trend), proportion of patients reaching the intensive target of BP < 140/80 mmHg at baseline and during the 12 months of follow-ups in total patients (p < 0.05 for trend) and in patients with hypertension (HTN) (p < 0.05 for trend). (C) Proportion of patients reaching the target of LDL-C <2.6 mmol/L at baseline and during the 12 months of follow-ups in total patients (p < 0.05 for trend) and in patients with dyslipidemia (DYLP) (p < 0.05 for trend). (D) Proportion of patients reaching the combined three therapeutic targets (HbA1c <7.0%, BP <140/90 mmHg and LDL-C <2.6 mmol/L) at baseline and during the 12 months of follow-ups (p < 0.05 for trend); proportion of patients reaching the combined three therapeutic targets (HbA1c <6.5%, BP <140/80 mmHg and LDL-C <2.6 mmol/L) at baseline and during the 12 months of follow-ups (p < 0.05 for trend).

Figure 2

Proportion of patients reaching the target of HbA1c A) Proportion of patients reaching the target of HbA1c <7.0% at baseline and during the 12 months of follow-ups in total patients (p < 0.05 for trend), in patients with diabetes only (p < 0.05 for trend), in patients with diabetes and hypertension (p < 0.05 for trend), in patients with diabetes and dyslipidemia (p < 0.05 for trend), in patients with diabetes, hypertension and dyslipidemia (p < 0.05 for trend). (B) Proportion of patients reaching the target of BP <140/90 mmHg at baseline and during the 12 months of follow-ups in total patients (p < 0.05 for trend), in patients with diabetes only (p < 0.05 for trend), in patients with diabetes and hypertension (p < 0.05 for trend), in patients with diabetes and dyslipidemia (p < 0.05 for trend), in patients with diabetes, hypertension and dyslipidemia (p < 0.05 for trend). (C) Proportion of patients reaching the target of LDL-C <2.6 mmol/L at baseline and during the 12 months of follow-ups in total patients (p < 0.05 for trend), in patients with diabetes only (p < 0.05 for trend), in patients with diabetes and hypertension (p < 0.05 for trend), in patients with diabetes and dyslipidemia (p < 0.05 for trend), in patients with diabetes, hypertension and dyslipidemia (p < 0.05 for trend). (D) Proportion of patients reaching the three targets of HbA1c <7.0%, BP <140/90 mmHg and LDL-C <2.6 mmol/L altogether at baseline and during the 12 months of follow-ups in total patients (p < 0.05 for trend), in patients with diabetes only (p < 0.05 for trend), in patients with diabetes and hypertension (p < 0.05 for trend), in patients with diabetes and dyslipidemia (p < 0.05 for trend), in patients with diabetes, hypertension and dyslipidemia (p < 0.05 for trend).

Figure 3

Changes in HbA1c and glucose level, SBP and DBP, lipid profiles, body weight and BMI in newly diagnosed type 2 diabetic patients within 12 months of follow-ups. (A) Changes in HbA1c (p < 0.05 for trend) and fasting glucose level (p < 0.05 for trend) within 12 months of follow-ups. (B) Changes in SBP (p < 0.05 for trend) and DBP (p < 0.05 for trend) within 12 months of follow-ups. (C) Changes in TC (p < 0.05 for trend), TG (p < 0.05 for trend), LDL-c (p < 0.05 for trend) and HDL-c (p < 0.05 for trend) within 12 months of follow-ups. (D) Changes in body weight (p < 0.05 for trend) and BMI (p < 0.05 for trend) within 12 months of follow-ups.

Figure 4

Association between adverse event and current medication.

Figure 5

Proportion of hypoglycemic medications identified in reported adverse events.