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Observational Study
. 2015 May 2:15:23.
doi: 10.1186/s12902-015-0020-7.

Achievement of individualized treatment targets in patients with comorbid type-2 diabetes and hypertension: 6 months results of the DIALOGUE registry

Roland E Schmieder  1 , Anselm K Gitt  2   3 , Cornelia Koch  4 , Peter Bramlage  5 , Taoufik Ouarrak  6 , Diethelm Tschöpe  7   8 ; DIALOGUE study group
Affiliations
Observational Study

Achievement of individualized treatment targets in patients with comorbid type-2 diabetes and hypertension: 6 months results of the DIALOGUE registry

Roland E Schmieder et al. BMC Endocr Disord. .

Abstract

Background: Patients with type-2 diabetes mellitus (T2DM) and hypertension have increased risk of cardiovascular disease (CVD). We studied individualized treatment targets and their achievement in clinical practice.

Methods: DIALOGUE is a prospective, multi-center registry in patients with both T2DM and hypertension.

Results: Patients (n = 6,586) had a baseline fasting glucose (8.5 ± 2.8 mmol/l), postprandial glucose (10.9 ± 3.4 mmol/l), and HbA1c (7.8 ± 2.1%) levels indicated poor glycemic control. Baseline systolic and diastolic BP were 140.3 ± 15.7 and 82.6 ± 9.5, respectively. Patients were categorized by HbA1c treatment goals: ≤6.5% (strict), >6.5 to ≤7.0% (medium), and >7.0 to ≤7.5% (loose). When considering systolic BP (SBP) targets (≤130 mmHg [strict], >130 to ≤135 mmHg [medium], and >135 to ≤140 mmHg [loose]), patients with strict SBP treatment goals displayed similar characteristics to those with strict HbA1c targets. Although approximately 70% of patients received both strict HbA1c and SBP targeting, overall treatment goals remained unmet in all HbA1c target groups at the 6-month follow-up. SBP targets were not reached in the strict and medium groups, but were achieved in the loose treatment group. Specific predictors for choosing loose SBP or HbA1c treatment goals were identified, including SBP/HbA1c levels and various comorbidities.

Conclusions: Individualized glucose and BP targets were selected by treating physicians based on patient characteristics and overall comorbidity. While treatment goals were not consistently met using various antidiabetic and antihypertensive therapies, our analyses indicated that the strictly targeted patient populations maintained lower overall HbA1c and SBP levels at 6 months.

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Figures

Figure 1
Figure 1
Comorbidities according to HbA1c (upper panel) and BP (lower panel) target groups. Legend: HbA1c, glycated hemoglobin; SBP, systolic blood pressure; TIA, transient ischemic attack; PAD, peripheral arterial disease; NPDR, non-proliferative diabetic retinopathy.
Figure 2
Figure 2
Proportion of patients with the indicated SBP goals within each HbA1c target group. Legend: SBP, systolic blood pressure; HbA1c, glycated hemoglobin. *P < 0.0001 for all comparisons between HbA1c target groups.
Figure 3
Figure 3
Target achievement rates at 6 months in each HbA1c and blood pressure target group.
Figure 4
Figure 4
HbA1c/SBP distribution at 6 months overall and by comorbidity.
See this image and copyright information in PMC

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