Differences in complications, cardiovascular risk factor, and diabetes management among participants enrolled at veterans affairs (VA) and non-VA medical centers in the glycemia reduction approaches in diabetes: A comparative effectiveness study (GRADE)

Authors

Hermes J. Florez, Medical University of South Carolina
Alokananda Ghosh, Milken Institute School of Public Health
Rodica Pop-Busui, University of Michigan Medical School
Sophia H. Hox, VA Medical Center
Chantal Underkofler, University of Colorado School of Medicine
M. Diane McKee, University of Massachusetts Chan Medical School
Jean Park, MedStar Health
Mary K. Rhee, Emory University School of Medicine
Tina Killean, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Heidi Krause-Steinrauf, Milken Institute School of Public Health
Vanita R. Aroda, MedStar Health
Deborah J. Wexler, Massachusetts General Hospital

Document Type

Journal Article

Publication Date

2-1-2022

Journal

Diabetes Research and Clinical Practice

Volume

184

DOI

10.1016/j.diabres.2021.109188

Keywords

Cardiovascular disease; Chronic disease; Complications; Management; Risk factor; Type 2 diabetes

Abstract

Aims: We evaluated differences in participants with type 2 diabetes (T2DM) enrolled in the GRADE study at VA vs non-VA sites, focusing on cardiovascular risk factors and rates of diabetes care target achievements. Methods: We compared baseline characteristics between participants at VA (n = 1216) and non-VA (n = 3831) sites, stratifying analyses by cardiovascular disease (CVD) history. Results: VA and non-VA participants had similar diabetes duration (4.0 years), HbA1c (7.5%), and BMI (34 kg/m2); however, VA participants had more individuals ≥ 65 years (37.3% vs 19.8%, p < 0.001), men (90.0% vs 55.2%, p < 0.001), hypertension (75.8% vs 63.6%, p < 0.001), hyperlipidemia (76.6% vs 64.6%, p < 0.001), current smokers (19.0% vs 12.1%, p < 0.001), nephropathy (20.4% vs 17.0%, p < 0.05), albuminuria (18.4% vs 15.1%, p < 0.05), and CVD (10.4% vs 5.2%, p < 0.001). In those without CVD, more VA participants were treated with lipid (70.8% vs 59.5%, p < 0.001) and blood pressure (74.9% vs 65.4%, p < 0.001) lowering medications, and had LDL-C < 70 mg/dl (32.9% vs 24.2%, p < 0.05). Among those with CVD, more VA participants had BP < 140/90 (80.2% vs 70.1%, p < 0.05) after adjusting for demographics. Conclusion: GRADE participants at VA sites had more T2DM complications, greater CVD risk and were more likely to be treated with medications to reduce it, leading to more LDL-C at goal than non-VA participants, highlighting differences in diabetes populations and care.

APA Citation

Florez, Hermes J.; Ghosh, Alokananda; Pop-Busui, Rodica; Hox, Sophia H.; Underkofler, Chantal; McKee, M. Diane; Park, Jean; Rhee, Mary K.; Killean, Tina; Krause-Steinrauf, Heidi; Aroda, Vanita R.; and Wexler, Deborah J., "Differences in complications, cardiovascular risk factor, and diabetes management among participants enrolled at veterans affairs (VA) and non-VA medical centers in the glycemia reduction approaches in diabetes: A comparative effectiveness study (GRADE)" (2022). GW Authored Works. Paper 17.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/17