(ORDO NEWS) — Importance: Improvements in the control of diabetes risk factors in the US have stalled and remain suboptimal. The benefits of continual improvement in goal achievement have not yet been assessed.
Objective: To quantify the potential increase in life expectancy (LE) among people with type 2 diabetes (T2DM) associated with reductions in glycated hemoglobin (HbA1c), systolic blood pressure (SBP), low-density lipoprotein (LDL-C) cholesterol, and body mass index (BMI) to the optimal level.
Conditions and Participants: In this analytic decision model, the Building, Relating, Assessing, and Validating Outcomes (BRAVO) diabetes microsimulation model was calibrated against a nationally representative sample of adults with T2D from the National Health and Nutrition Survey (2015-2016) using their associated data on short-term mortality from the National Mortality Index.
The model was then used to conduct a simulation experiment on the study population throughout life. The data was analyzed from January to October 2021.
Impact: The study population was categorized into quartiles for HbA1c, SBP, LDL-C and BMI levels. The increase in LE associated with achieving better control was assessed by moving people with T2D from the current quartile of each biomarker to lower quartiles.
Main results and indicators: Life expectancy.
Results: Among 421 subjects, 194 (46%) were women, mean age (SD) was 65.6 (8.9) years. Compared with a BMI of 41.4 (fourth quartile mean), lower BMIs of 24.3 (first), 28.6 (second), and 33.0 (third) were associated with 3.9, 2.9, and 2.0 additional years of life, respectively, in people with T2D.
Compared to an SBP level of 160.4 mmHg. Art. (fourth), lower SBP levels 114.1 mmHg. Art. (first), 128.2 mmHg Art. (second) and 139.1 mm Hg. Art. (third) were associated with 1.9, 1.5 and 1.1 years of life, respectively, in people with T2D.
Lower LDL levels to 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 of life expectancy compared to an LDL level of 146.2 mg/dL (fourth). Reducing the level of HbA1c from 9.9% (fourth) to 7, 7% (third) was associated with a 3.4 year increase in life expectancy.
However, a further decrease to 6.8% (group 2) was associated only with an average increase in PVC by 0.5 years, and a decrease from 6.8% to 5.9% (group 1) was not associated with a benefit for PVC. Overall, a decrease in HbA1c levels from the fourth to the first quartile is associated with a 3.8-year increase in life expectancy.
Conclusions and Relevance: These results can be used by physicians to motivate patients to achieve recommended treatment goals and to prioritize interventions and programs to improve diabetes care in the United States.
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