Cardiovascular Risk Factor Control Among Veterans With Diabetes
The Ambulatory Care Quality Improvement Project
- Nicholas L. Smith, PHD12,
- Leway Chen, MD3,
- David H. Au, MD4,
- Mary McDonell, MS4 and
- Stephan D. Fihn, MD4
- 1Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington
- 2Department of Epidemiology, University of Washington, Seattle, Washington
- 3Cardiology Unit, University of Rochester Medical Center, Rochester, New York
- 4Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington
- Address correspondence and reprint requests to Nicholas L. Smith, PhD, MPH, Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle Division, 1660 South Columbian Way, Mailstop 152E, Seattle, WA 98108. E-mail: nlsmith{at}u.washington.edu
Abstract
OBJECTIVE—To describe the extent to which hyperglycemia, hypertension, and dyslipidemia are currently detected, treated, and controlled in U.S. veterans with diabetes with and without ischemic heart disease (IHD).
RESEARCH DESIGN AND METHODS—A cohort of 3,769 veterans who self-reported diabetes and who received all health care from the Veterans Administration (VA) medical centers were selected from subjects enrolled in the Ambulatory Care Quality Improvement Project, a randomized health services intervention at seven VA primary care clinics. IHD was defined by a self-reported history of myocardial ischemia, infarction, or revascularization. Mean values of HbA1c, blood pressure, and cholesterol subfractions were collected from computerized laboratory databases. Medication data were collected from computerized pharmacy databases.
RESULTS—Mean HbA1c and optimal control (HbA1c <7%) did not differ for those without and with IHD: 8.1 vs. 8.0%, and 26 vs. 24%, respectively. Veterans with IHD were more likely to have hypertension (73 vs. 64%), to be treated (88 vs. 78%), and to have optimal blood pressure control (19 vs. 10%) compared with veterans without IHD (all P values <0.01). Veterans with IHD were more likely to have dyslipidemia (81 vs. 53%), were equally likely to be treated (54 vs. 50%), and were more likely to have optimal LDL levels (30 vs. 16%) compared with veterans without IHD, all P values <0.01.
CONCLUSIONS—Optimal cardiovascular risk factor control was the exception in this cohort of diabetic veterans attending primary care clinics. More aggressive management of cardiovascular risk factors in veterans with diabetes may be warranted, especially among those without prevalent IHD.
- ACQUIP, Ambulatory Care Quality Improvement Project
- ADA, American Diabetes Association
- IHD, ischemic heart disease
- VA, Veterans Administration
Footnotes
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Funding for this supplement was provided by The Seattle Epidemiologic Research and Information Center and the VA Cooperative Studies Program.
N.L.S. is currently an investigator at the Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
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- Accepted July 25, 2003.
- Received July 1, 2003.
- DIABETES CARE
