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

1. Emily B. Schroeder, MD, PhD,
2. Rebecca Hanratty, MD,
3. Brenda L. Beaty, MSPH,
4. Elizabeth A. Bayliss, MD, MSPH,
5. Edward P. Havranek, MD and
6. 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 emily.x.schroeder@kp.org

Abstract

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 (HbA_1c) <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.