Simultaneous control of intermediate diabetes outcomes among Veterans Affairs primary care patients

J Gen Intern Med. 2006 Oct;21(10):1050-6. doi: 10.1111/j.1525-1497.2006.00519.x.


Background: Guidelines recommend tight control of hemoglobin A1c (HbA1c), low-density lipoprotein cholesterol (LDL-C), and blood pressure (BP) for patients with diabetes. The degree to which these intermediate outcomes are simultaneously controlled has not been extensively described.

Objective: Describe the degree of simultaneous control of HbA1c, LDL-C, and BP among Veterans Affairs (VA) diabetes patients defined by both VA and American Diabetes Association (ADA) guidelines.

Design: Cross-sectional cohort.

Patients: Eighty-thousand two hundred and seven VA diabetes patients receiving care between October 1999 and September 2000.

Measurments: We defined simultaneous control of outcomes using 1997 VA Guidelines (in place in 2000) (HbA1c < 9.0%; LDL-C < 130 mg/dL; systolic BP < 140 mmHg; and diastolic BP < 90 mmHg) and 2004 ADA guidelines (HbA1c < 7.0%; LDL-C < 100 mg/dL; systolic BP < 130 mmHg; and diastolic BP < 80 mmHg). A patient is considered to have simultaneous control of the intermediate outcomes for a given definition if the average of measurements for each outcome was below the defined threshold during the study period.

Results: Using VA guidelines, 31% of patients had simultaneous control. Control levels of individual outcomes were: HbA1c (82%), LDL-C (77%), and BP (48%). Using ADA guidelines, 4% had simultaneous control. Control levels of individual outcomes were: HbA1c (36%), LDL-C (41%), and BP (23%). Associations between individual risk factors were weak. There was a modest association between LDL-C control and control of HbA1c (odds ratio [OR] 1.51; 95% confidence interval [CI] 1.44, 1.58). The association between LDL-C and BP control was clinically small (1.26; 1.21, 1.31), and there was an extremely small association between BP and HbA1c control (0.95; 0.92, 0.99). Logistic regression modeling indicates greater body mass index, African American or Hispanic race-ethnicity, and female gender were negatively associated with simultaneous control.

Conclusion: While the proportion of patients who achieved minimal levels of control of HbA1c and LDL-C was high, these data indicate a low level of simultaneous control of HbA1c, LDL-C, and BP among patients with diabetes.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / epidemiology*
  • Diabetes Mellitus, Type 2 / therapy*
  • Female
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Male
  • Middle Aged
  • Primary Health Care* / methods
  • Registries
  • Risk Factors
  • Treatment Outcome
  • United States
  • United States Department of Veterans Affairs*
  • Veterans*


  • Glycated Hemoglobin A