The association of patient age with cardiovascular disease risk factor treatment and control in diabetes

J Gen Intern Med. 2009 Sep;24(9):1049-52. doi: 10.1007/s11606-009-1059-9. Epub 2009 Jul 15.

Abstract

Background: While inadequate treatment intensification may contribute to sub-optimal CVD risk factor control in older patients with diabetes, the relationship between patient age and treatment intensification is largely unexplored.

Objective: To examine differences in treatment intensification and control for blood pressure (BP), lipids and A1c in older vs. younger adults with diabetes.

Methods: A total of 161,697 Kaiser Permanente Northern California adult diabetes patients were stratified by age (<50, 50-64, 65-74 and 75-85) and assessed for control of A1c (<8%), LDL-c (<100 mg/dl) and SBP (<140 mmHg). Probit models assessed the marginal effects of patient age on treatment intensification and control for all three CVD risk factors.

Results: Patients aged 50-64 and 65-74 were significantly more likely to receive treatment intensification for elevated SBP than patients under 50 (74% and 76% vs. 71%) and significantly less likely to receive treatment intensification for elevated A1c (73% and 72% vs. 76%), with no differences noted for LDL-c treatment. Older patients had significantly worse SBP control, but better control of A1c and LDL-c.

Conclusions: Both treatment intensification rates and control of BP, A1c and LDL cholesterol control varied somewhat by age, suggesting room for further improvement in treatment intensification and control.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / complications*
  • Cardiovascular Diseases / physiopathology
  • Cardiovascular Diseases / therapy*
  • Diabetes Mellitus / physiopathology
  • Diabetes Mellitus / therapy*
  • Female
  • Glycated Hemoglobin / metabolism
  • Humans
  • Male
  • Middle Aged
  • Patient Care / methods*
  • Patient Care / trends
  • Risk Factors
  • Systole
  • Treatment Outcome
  • Young Adult

Substances

  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human