By Austin Ulrich, PharmD, BCACP
Consultant Pharmacist, Ulrich Medical Writing LLC, Greensboro, NC
SYNOPSIS: Investigators analyzed gains in life expectancy (LE) by achieving treatment goals, finding significant gains from lower body mass index, glycated hemoglobin, systolic blood pressure, and low-density lipoprotein cholesterol.
SOURCE: Kianmehr H, Zhang P, Luo J, et al. Potential gains in life expectancy associated with achieving treatment goals in US adults with type 2 diabetes. JAMA Netw Open 2022;5:e227705.
The life expectancy (LE) for patients with type 2 diabetes mellitus (T2DM) is an estimated six years shorter vs. those without T2DM at age 50 years.1 Shorter LE is thought to result from complications associated with diabetes, such as increased cardiovascular risk and nephropathy.2 However, improvement in therapeutic targets for T2DM, such as blood glucose, cholesterol, blood pressure (BP), and body mass index (BMI), reduces complications and mortality from diabetes, resulting in longer LE.3
Quantifying LE improvement based on achieving therapeutic targets can be helpful for practicing clinicians to help motivate patients to adopt behaviors that improve these targets. Additionally, gains in LE from specific outcomes can inform public health policy aimed at optimizing care for those with T2DM.
To quantify LE associated with key therapeutic targets in patients with T2DM, Kianmehr et al used Building, Relating, Assessing, and Validating Outcomes (BRAVO) diabetes model to assess patient data from the 2015-2016 National Health and Nutrition Examination Survey (NHANES). The validated and calibrated BRAVO diabetes model develops a current risk profile for patients and projects long-term outcomes, such as mortality and diabetes-related complications. It is based on risk equations that were developed from the ACCORD trial.4 Factors considered in the model include BMI, glycated hemoglobin (HbA1c), systolic BP (SBP), and low-density lipoprotein cholesterol (LDL-C).
There were 421 patients from the NHANES population with T2DM (average age = 65.6 years; about 46% were women). Therapeutic targets were grouped into quartiles represented by mean values, and results were compared between quartiles. For patients with BMI greater than 36 kg/m2, lowering BMI to less than 25 kg/m2 resulted in a 3.9-year gain in LE. For patients in the quartile with HbA1c 9.9%, reducing the HbA1c to the 7.7% quartile resulted in a 3.4-year gain in LE. A smaller gain in LE of 0.5 years was observed with improvement of HbA1c from quartiles 7.7% to 6.8%.
For patients in the quartile with SBP 160.4 mmHg, reducing SBP to the 128.2 mmHg quartile resulted in a 1.5-year LE gain. Finally, compared with patients in the LDL-C quartile with a mean measurement of 146.2 mg/dL, reducing LDL to the 84.0 mg/dL quartile resulted in a LE gain of 0.5 years. Notably, benefits of achieving treatment goals declined as age increased. The authors concluded each of the four biomarkers assessed resulted in LE gains with differing patterns and magnitudes. Clinicians and patients can use these findings to determine optimal treatment goals and increase motivation to reach those targets.
COMMENTARY
The gains in LE in this study were substantial, highlighting the importance of achieving therapeutic targets in T2DM. For example, the authors estimated for a patient with high BMI, HbA1c, SBP, and LDL-C readings, controlling biomarkers could result in LE gains of longer than 10 years. Although the most significant LE gains were observed with improvement from the highest quartile to the lowest quartile, LE gains in this analysis were estimated to be proportional, meaning even smaller improvements in therapeutic targets still extends LE, albeit to a lesser degree. The observation that biomarker improvement results in lower LE gains as age increases emphasizes the need to focus on reaching therapeutic targets early in the disease process for maximal benefit.
Despite the recognized benefits of controlling biomarker risk factors in T2DM, patients (and even clinicians) struggle with a lack of urgency to reach therapeutic targets.5 Various initiatives are targeted at improving patients’ motivation to control blood glucose and other measures.
Tailoring education to individuals can help empower them to take responsibility for their health.5 Clinicians can remind patients with T2DM there can be significant improvements in LE from reaching treatment goals.
REFERENCES
- Rao Kondapally Seshasai S, Kaptoge S, Thompson A, et al. Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med 2011;364:829-841.
- Baena-Díez JM, Peñafiel J, Subirana I, et al. Risk of cause-specific death in individuals with diabetes: A competing risks analysis. Diabetes Care 2016;39:1987-1995.
- Leal J, Gray AM, Clarke PM. Development of life-expectancy tables for people with type 2 diabetes. Eur Heart J 2009;30:834-839.
- Shao H, Fonseca V, Stoecker C, et al. Novel risk engine for diabetes progression and mortality in USA: Building, Relating, Assessing, and Validating Outcomes (BRAVO). Pharmacoeconomics 2018;36:1125-1134.
- Edelman SV. Taking control of your diabetes: An innovative approach to improving diabetes care through educating, motivating, and making the connection between patients and health care providers. Clin Diabetes 2017;35:333-339.
Investigators analyzed gains in life expectancy by achieving treatment goals, finding significant gains from lower body mass index, glycated hemoglobin, systolic blood pressure, and low-density lipoprotein cholesterol.
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