Cardiovascular combined target in type 2 Diabetes: sex and socio-economic status differences in primary care.

Sara Ares Blanco, Elena Polentinos-Castro, Francisco Rodríguez-Cabrera, Ileana Gefaell, Luis Sánchez Perruca, Isabel Del Cura González

Keywords: Type 2 diabetes mellitus, sex, primary healthcare, healthcare disparities, observational study

Few patients with type 2 diabetes (T2D) can achieve the combined target: HbA1c ≤ 7%, blood pressure ≤ 140/90 mm Hg, LDL <100 mg/dl. Patients with suboptimal control are at risk of more complications especially low socio-economic status (SES) patients and in women.

Research questions:
Are there differences in achieving combined target control by sex and socio-economic status in T2D?

Observational, retrospective study based in patients with T2D between 40-75 years in primary care in Madrid (n: 68,535) during 2017-2018.
Primary outcome: combined control (HbA1c ≤ 7%, BP≤ 140/90 mm Hg, LDL<100 mg/dl).
Secondary outcome: Sociodemographic factors, cardiovascular risk factors, micro and macrovascular complications. Descriptive, bivariate analyses and multilevel logistic regression models were performed.

The mean age was 62.7 years, women: 43.2%. Low SES: 41%. Women had more hypertension (67.2%), and dyslipidaemia (62.7%). Men were more obese (51.1%) and smokers (21.8%).

The optimal combined target was reached by 10% of patients (women: 9.3% vs men: 11.2%, p<0.001), Those in lowest SES obtained better combined targets than those in highest SES (men: 13.4% vs 11.1%, women: 10.6% vs 9.5%). Women had worst combined targets regardless of the SES. Multilevel analysis was performed to analyse the effect of sex and SES: being female (AOR: 1.26, 95%CI: 1.19-1.34), belonging to the lowest SES (AOR: 1.09, 95% CI: 0.77-1.54) and having retinopathy (AOR: 1.44, 95% CI: 1.18-1.75) was associated to suboptimal combined target.

Complications were more frequent in men, men in the highest SES had more coronary heart disease (CHD) and strokes. Women in the lowest SES had more CHD, strokes and retinopathy.

Optimal combined control target was seldom achieved, men and patients in lowest SES were the ones who achieved it most.

Points for discussion:
Is realistic to reach combined target in T2D?

Which target should we prioritize when we can´t achieve all the targets?