Simultaneous control of diabetes mellitus, hypertension, and hyperlipidemia in 2 health systems

Abstract

Background: Many individuals with diabetes mellitus, hypertension, and hyperlipidemia have difficulty achieving control of all 3 conditions. We assessed the incidence and duration of simultaneous control of hyperglycemia, blood pressure, and low-density lipoprotein cholesterol in patients from 2 health care systems in Colorado.

Methods and results: We performed a retrospective cohort study of adults at Denver Health and Kaiser Permanente Colorado with diabetes mellitus, hypertension, and hyperlipidemia from 2000 through 2008. Over a median of 4.0 and 4.4 years, 16% and 30% of individuals at Denver Health and Kaiser Permanente achieved the primary outcome (simultaneous control with a glycosylated hemoglobin (HbA(1c)) <7.0%, blood pressure <130/80 mm Hg, and low-density lipoprotein cholesterol <100 mg/dL), respectively. With less strict goals (HbA(1c) <8.0%, blood pressure <140/90 mm Hg, and low-density lipoprotein cholesterol <130 mg/dL), 44% and 70% of individuals at Denver Health and Kaiser Permanente achieved simultaneous control. Sociodemographic characteristics (increasing age, white ethnicity), and the presence of cardiovascular disease or other comorbidities were significantly but not strongly predictive of achieving simultaneous control in multivariable models. Simultaneous control was less likely as severity of the underlying conditions increased, and more likely as medication adherence increased.

Conclusions: Simultaneous control of diabetes mellitus, hypertension, and hyperlipidemia was uncommon and generally transient. Less stringent goals had a relatively large effect on the proportion achieving simultaneous control. Individuals who simultaneously achieve multiple treatment goals may provide insight into self-care strategies for individuals with comorbid health conditions.

Figure 1

Achievement and maintenance of simultaneous control of HbA_1c, blood pressure, and LDL cholesterol in two Colorado cohorts of individuals with diabetes, hypertension, and hyperlipidemia.

Figure 2

Effect of varying goals for HbA_1c blood pressure (BP), and LDL cholesterol (LDL-C) on the percent ever achieving simultaneous control.