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Life Expectancy and Achieving Treatment Goals in Type 2 Diabetes
Quick Takes
- Differences in HbA1c and BMI were found to have the strongest association with life expectancy gain from a population perspective.
- Better control of biomarkers can potentially increase the life expectancy by 3 years in an average person with type 2 diabetes in the US.
- The study findings can be used by clinicians and patients in selecting optimal therapeutic goals and to measure potential health benefits for interventions and programs to improve diabetes care and outcomes in the US.
Study Questions:
What are the potential gains in life expectancy (LE) among people with type 2 diabetes (T2D) associated with lowering glycated hemoglobin (HbA1c), systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and body mass index (BMI) toward optimal levels?
Methods:
The investigators used a decision analytical model, and calibrated the Building, Relating, Assessing, and Validating Outcomes (BRAVO) diabetes microsimulation model to a nationally representative sample of adults with T2D from the National Health and Nutrition Examination Survey (2015-2016) using their linked short-term mortality data from the National Death Index. The model was then used to conduct the simulation experiment on the study population over a lifetime. Data were analyzed from January to October 2021. The study population was grouped into quartiles based on levels of HbA1c, SBP, LDL-C, and BMI. LE gains associated with achieving better control were estimated by moving people with T2D from the current quartile of each biomarker to the lower quartiles. The main outcome and measure was life expectancy. The BRAVO diabetes model uses the patients’ risk profile to populate the simulation of the diabetes progression and estimate the corresponding LE.
Results:
Among 421 individuals, 194 (46%) were women, and the mean (standard deviation) age was 65.6 (8.9) years. Compared with a BMI of 41.4 (mean of the fourth quartile), lower BMIs of 24.3 (first), 28.6 (second), and 33.0 (third) were associated with 3.9, 2.9, and 2.0 additional life-years, respectively, in people with T2D. Compared with an SBP of 160.4 mm Hg (fourth), lower SBP levels of 114.1 mm Hg (first), 128.2 mm Hg (second), and 139.1 mm Hg (third) were associated with 1.9, 1.5, and 1.1 years gained in LE in people with T2D, respectively. Lower LDL-C levels of 59 mg/dL (first), 84.0 mg/dL (second), and 107.0 mg/dL (third) were associated with 0.9, 0.7, and 0.5 years gained in LE, compared with LDL-C of 146.2 mg/dL (fourth). Reducing HbA1c from 9.9% (fourth) to 7.7% (third) was associated with 3.4 years gained in LE. However, a further reduction to 6.8% (second) was associated with only a mean of 0.5 years gained in LE, and from 6.8% to 5.9% (first) was not associated with LE benefit. Overall, reducing HbA1c from the fourth quartile to the first is associated with an LE gain of 3.8 years.
Conclusions:
The authors concluded that increased LE with optimal treatment goals can be used by clinicians to motivate patients in achieving the recommended treatment goals and to help prioritize interventions and programs to improve diabetes care in the US.
Perspective:
This study quantified the potential gains in LE associated with different levels of biomarkers in patients with diabetes and reports that differences in HbA1c and BMI were found to have the strongest association with LE gain from a population perspective. Overall, better control of biomarkers can potentially increase the LE by 3 years in an average person with T2D in the US and for individuals with very high levels of HbA1c, SBP, LDL-C, and BMI, controlling biomarkers can likely increase LE by more than a decade. The study findings can be used by clinicians and patients in selecting optimal therapeutic goals, motivating patients in achieving them, and to measure potential health benefits for interventions and programs to improve diabetes care and outcomes in the US.
Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins
Keywords: Biomarkers, Blood Pressure, Body Mass Index, Cholesterol, LDL, Diabetes Mellitus, Type 2, Glycated Hemoglobin A, Life Expectancy, Metabolic Syndrome, Primary Prevention, Vascular Diseases
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