The effect of controlling the ABC’s of diabetes on cardiovascular disease in a community-based endocrinology practice

Introduction: Large clinical trials demonstrate that glycemic, blood pressure, and cholesterol control lead to risk reduction in cardiovascular events. We determined whether A1c, blood pressure, and cholesterol control were associated with incident cardiovascular disease [CVD] in a community-based endocrinology practice over 10 years. Methods: 385 consecutive patients seen for diabetes management in a CBEP comprised the analysis cohort. To be included, a patient had ≥2 A1c, blood pressure, and LDLc measurements respectively without prevalent CVD. All patients were 18 years or older with a diagnosis of diabetes before or during calendar year 2000. Results: 17.6% of patients developed incident CVD over 10 years. After controlling for age, gender, and time, patients who improved their A1c to <7% during the time they spent in the practice had a 47% reduction in incident CVD [hazard rate = 0.53, 95% CI: 0.26 - 1.1]. Similar trends were observed for LDLc [27% reduction, hazard rate = 0.73, 95% CI: 0.3 - 1.8] and blood pressure control [35% reduction, hazard rate = 0.65, 95% CI: 0.33 - 1.3]. Additionally, patients who achieved all ABCSs at goal level at least once were 2.5x more likely not to develop incident CVD [hazard rate = 2.5, 95% CI: 1.2, 5.1] during their time in the practice. Conclusion: These results highlight the feasibility of achieving A1c, blood pressure, and cholesterol goals and demonstrate the significant impact that control has on incident CVD in a community-based endocrinology practice. Models of care that focus on prevention of complications through A1c, blood pressure, and cholesterol control may lead to decreased morbidity and mortality.