viernes, 17 de agosto de 2012

Simultaneous Control of Diabetes Mellitus, Hypertension, and Hyperlipidemia in 2 Health Systems

  1. John F. Steiner, MD, MPH

+ Author Affiliations: From the Institute for Health Research, Kaiser Permanente Colorado, Denver (E.B.S., E.A.B., J.F.S.); Department of Medicine, University of Colorado Denver (E.B.S.); Denver Health, Denver, CO (R.H., E.P.H.); Colorado Health Outcomes Program, University of Colorado Denver (B.L.B.); and Department of Family Medicine, University of Colorado Denver (E.A.B.).                          Correspondence to Emily B. Schroeder, MD, PhD, Institute for Health Research, Kaiser Permanente Colorado, PO Box 378066, Denver, CO 80237-8066. E-mail


Background—Many individuals with diabetes mellitus, hypertension, and hyperlipidemia have difficulty achieving control of all 3 conditions. We assessed the incidence and duration of simultaneous control of hyperglycemia, blood pressure, and low-density lipoprotein cholesterol in patients from 2 health care systems in Colorado.
Methods and Results—We performed a retrospective cohort study of adults at Denver Health and Kaiser Permanente Colorado with diabetes mellitus, hypertension, and hyperlipidemia from 2000 through 2008. Over a median of 4.0 and 4.4 years, 16% and 30% of individuals at Denver Health and Kaiser Permanente achieved the primary outcome (simultaneous control with a glycosylated hemoglobin (HbA1c) <7 .0=".0" and="and" ba="ba" blood="blood" cholesterol="cholesterol" dl="dl" goals="goals" hg="hg" less="less" lipoprotein="lipoprotein" low-density="low-density" mg="mg" mm="mm" pressure="pressure" respectively.="respectively." strict="strict" sub="sub" with="with">1c
<8 .0=".0" 44="44" 70="70" achieved="achieved" achieving="achieving" adherence="adherence" age="age" and="and" as="as" at="at" blood="blood" but="but" cardiovascular="cardiovascular" characteristics="characteristics" cholesterol="cholesterol" comorbidities="comorbidities" conditions="conditions" control.="control." control="control" denver="denver" disease="disease" dl="dl" ethnicity="ethnicity" health="health" hg="hg" in="in" increased.="increased." increased="increased" increasing="increasing" individuals="individuals" kaiser="kaiser" less="less" likely="likely" lipoprotein="lipoprotein" low-density="low-density" medication="medication" mg="mg" mm="mm" models.="models." more="more" multivariable="multivariable" not="not" of="of" or="or" other="other" p="p" permanente="permanente" predictive="predictive" presence="presence" pressure="pressure" severity="severity" significantly="significantly" simultaneous="simultaneous" sociodemographic="sociodemographic" strongly="strongly" the="the" underlying="underlying" was="was" were="were" white="white">
Conclusions—Simultaneous control of diabetes mellitus, hypertension, and hyperlipidemia was uncommon and generally transient. Less stringent goals had a relatively large effect on the proportion achieving simultaneous control. Individuals who simultaneously achieve multiple treatment goals may provide insight into self-care strategies for individuals with comorbid health conditions.

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