Impact of metabolic control on all-cause mortality in a nationwide cohort of patients with diabetes from Colombia

Abstract

ObjectiveThe magnitude of the mortality benefit conferred by good integral metabolic control in diabetes in not sufficiently known, especially among Latin American patients. We prospectively studied the association between sustained control of blood glucose (HbA1c<7%), systolic blood pressure (SBP) (<130 mmHg) and LDL (LDLc, <100mg/dL) and non-HDL (non-HDLc, <130 mg/dL) cholesterol, and death from any cause among all adult patients with diagnosed diabetes in Colombia.MethodsWe retrospectively analyzed data from a nationwide, centralized, mandatory registry of all patients with diagnosed diabetes assisted by the Colombian health system between July 1, 2015, and June 30, 2019. We estimated the associations of sustained achievement of each goal, and of the joint triple goal (HbA1c + SBP + LDLc) with all-cause death. Associations were assessed after adjustment for sex, age, race, insurance type and BMI in multivariable logistic models.ResultsWe studied 1 352 846 people with diabetes. Sustained SBP (OR 0.42 [0.41-0.43]), HbA1c (OR 0.25 [0.24-0.26]) and LDLc (OR 0.28 [0.27-0.29]) control had strong negative associations with death. Moreover, among the 5.4% of participants who achieved joint, sustained metabolic control, the OR for death was 0.19 (0.18-0.21). Importantly, the impact of sustained, joint metabolic control was significantly smaller for patients of black race compared to other races (OR 0.31 [0.23-0.43] versus 0.18 [0.17-0.20], p-value for interaction <0.001), mostly at the expense of a smaller impact of LDLc control. The results were similar across body-mass index categories.ConclusionsSustained and simultaneous metabolic control was associated with remarkably lower odds of death.

The Rationale for Using Fixed-Dose Combination Therapy in the Management of Hypertension in Colombia: A Narrative Review

“…The reported prevalence of hypertension in Colombia depends on the sampled population (Table 1 ), but hypertension affects between 28 and 44% of the adult population [ 10 , 11 , 15 – 18 ]. The prevalence increases with age [ 17 , 19 ], body mass index (BMI) [ 16 , 17 , 20 ], comorbidities [ 21 ], and correlates of low socioeconomic status, such as low education level and Afro-descendent ethnicity [ 15 , 17 , 18 ]. In Colombia and other middle-income countries, there is a clear relationship between wealth index and undetected hypertension, with poorer populations having lower rates of detection [ 14 ].…”

“…Reported BP control rates in Colombia vary from 37.1 to 66.4% (Table 1 ) [ 10 , 11 , 17 , 19 , 21 , 44 ]. In a primary care study by Barrera and colleagues, 38.4% of treated patients with hypertension had BP controlled to recommended levels.…”