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. 2022 Apr 1;5(4):e227705.
doi: 10.1001/jamanetworkopen.2022.7705.

Potential Gains in Life Expectancy Associated With Achieving Treatment Goals in US Adults With Type 2 Diabetes

Hamed Kianmehr  1 , Ping Zhang  2 , Jing Luo  3 , Jingchuan Guo  1   4 , Meda E Pavkov  2 , Kai McKeever Bullard  2 , Edward W Gregg  5 , Naykky Singh Ospina  6 , Vivian Fonseca  7 , Lizheng Shi  8 , Hui Shao  1   2   4
Affiliations

Potential Gains in Life Expectancy Associated With Achieving Treatment Goals in US Adults With Type 2 Diabetes

Hamed Kianmehr et al. JAMA Netw Open. .

Abstract

Importance: Improvements in control of factors associated with diabetes risk in the US have stalled and remain suboptimal. The benefit of continually improving goal achievement has not been evaluated to date.

Objective: To quantify potential gains in life expectancy (LE) among people with type 2 diabetes (T2D) associated with lowering glycated hemoglobin (HbA1c), systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and body mass index (BMI) toward optimal levels.

Design, setting, and participants: In this decision analytical model, the Building, Relating, Assessing, and Validating Outcomes (BRAVO) diabetes microsimulation model was calibrated to a nationally representative sample of adults with T2D from the National Health and Nutrition Examination Survey (2015-2016) using their linked short-term mortality data from the National Death Index. The model was then used to conduct the simulation experiment on the study population over a lifetime. Data were analyzed from January to October 2021.

Exposure: The study population was grouped into quartiles on the basis of levels of HbA1c, SBP, LDL-C, and BMI. LE gains associated with achieving better control were estimated by moving people with T2D from the current quartile of each biomarker to the lower quartiles.

Main outcomes and measures: Life expectancy.

Results: Among 421 individuals, 194 (46%) were women, and the mean (SD) age was 65.6 (8.9) years. Compared with a BMI of 41.4 (mean of the fourth quartile), lower BMIs of 24.3 (first), 28.6 (second), and 33.0 (third) were associated with 3.9, 2.9, and 2.0 additional life-years, respectively, in people with T2D. Compared with an SBP of 160.4 mm Hg (fourth), lower SBP levels of 114.1 mm Hg (first), 128.2 mm Hg (second), and 139.1 mm Hg (third) were associated with 1.9, 1.5, and 1.1 years gained in LE in people with T2D, respectively. A lower LDL-C level of 59 mg/dL (first), 84.0 mg/dL (second), and 107.0 mg/dL (third) were associated with 0.9, 0.7, and 0.5 years gain in LE, compared with LDL-C of 146.2 mg/dL (fourth). Reducing HbA1c from 9.9% (fourth) to 7.7% (third) was associated with 3.4 years gain in LE. However, a further reduction to 6.8% (second) was associated with only a mean of 0.5 years gain in LE, and from 6.8% to 5.9% (first) was not associated with LE benefit. Overall, reducing HbA1c from the fourth quartile to the first is associated with an LE gain of 3.8 years.

Conclusions and relevance: These findings can be used by clinicians to motivate patients in achieving the recommended treatment goals and to help prioritize interventions and programs to improve diabetes care in the US.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Luo reported receiving grants from the National Institute of Diabetes and Digestive and Kidney Diseases and grants from the National Center for Advancing Translational Sciences during the conduct of the study; grants from The Leona M. and Harry B. Helmsley Charitable Trust outside the submitted work. Dr Fonseca reported holding a patent for BRAVO Risk Engine pending. Dr Shao reported a holding patent for BRAVO microsimulation model pending at the University of Florida. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Cumulative Mortality Over 30 Years in Individuals With Type 2 Diabetes at Age 51 to 55 Years
Figure 2.
Figure 2.. Gains in Life-Years Associated With Different Levels of Biomarkers in Individuals With Type 2 Diabetes
The mean values of biomarkers for the first, second, third, and fourth quartile were as follows: glycated hemoglobin (HbA1c), 5.9%, 6.8%, and 7.7% vs 9.9% (to convert to proportion of total hemoglobin, multiply by 0.01); systolic blood pressure (SBP), 114.1 mm Hg, 128.1 mm Hg, and 139.1 mm Hg vs 160.4 mm Hg; low-density lipoprotein cholesterol (LDL-C), 58.9 mg/dL, 84.0 mg/dL, and 107.0 mg/dL vs 146 mg/dL (to convert to mmol/L, multiply by 0.0259), and body mass index (BMI, calculated as weight in kilograms divided by height in meters squared), 24.3, 28.6, and 33.0 vs 41.4.
Figure 3.
Figure 3.. The Estimated Remaining Life-Years in Men and Women With Type 2 Diabetes and Without Cardiovascular Diseases
The life expectancies are color-coded for each age-sex group separately. BMI indicates body mass index (calculated as weight in kilograms divided by height in meters squared); HbA1c, glycated hemoglobin (to convert to proportion of total hemoglobin, multiply by 0.01); LDL-C, low-density lipoprotein cholesterol (to convert to mmol/L, multiply by 0.0259); SBP, systolic blood pressure.
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Comment in

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