Elsevier

The American Journal of Medicine

Volume 126, Issue 10, October 2013, Pages 925.e11-925.e22
The American Journal of Medicine

AJM online
Clinical research study
Primacy of the 3B Approach to Control Risk Factors for Cardiovascular Disease in Type 2 Diabetes Patients

https://doi.org/10.1016/j.amjmed.2013.02.035Get rights and content

Abstract

Background

Individually, diabetes mellitus, hypertension, and dyslipidemia have been shown to increase the risk of cardiovascular disease. While traditional management of Type 2 diabetes has focused mainly on glycemic control, robust evidence supports the integration of hypertension and dyslipidemia management to reduce the risk of cardiovascular disease. The primary objective of this study was to assess the level of control of blood glucose, blood pressure, and blood lipids (3Bs) among patients with type 2 diabetes. An additional objective was to investigate the impact of hospital type, physician specialty, treatment pattern, and patient profile on clinical outcomes.

Methods

This was a cross-sectional, multicenter observational study. A nationally representative sample of outpatients with established type 2 diabetes were enrolled at hospitals representative of geographic regions, tiers, and physician specialties in China. Main clinical measurements were the levels of glycosylated hemoglobin (HbA1c), blood pressure, and total serum cholesterol in reference to target goals.

Results

A total of 25,817 adults with type 2 diabetes (mean age 62.6 years, 47% male) were enrolled at 104 hospitals. Seventy-two percent reported comorbid hypertension, dyslipidemia, or both. Patients with concurrent type 2 diabetes, hypertension, and dyslipidemia were 6 times more likely to report a prior history of cardiovascular disease compared with those with type 2 diabetes alone. The mean HbA1c level was 7.6%. While 47.7%, 28.4%, and 36.1% of patients achieved the individual target goals for control of blood glucose (HbA1c <7%), blood pressure (systolic blood pressure <130 mm Hg, diastolic blood pressure <80 mm Hg), and blood lipids (total cholesterol <4.5 mmol/L), respectively, only 5.6% achieved all 3 target goals. Lower body mass index (<24 kg/m2), no active smoking or drinking, higher education, and diabetes duration <5 years were independent predictors of better cardiovascular disease risk control.

Conclusion

Achieving adequate control of risk factors for cardiovascular disease in patients with type 2 diabetes remains a clinical challenge. Interventions to achieve control of 3Bs coupled with modification of additional cardiovascular disease predictors are crucial for optimization of clinical outcomes in patients with type 2 diabetes.

Section snippets

Objectives

The primary objective was to assess the proportion of patients who achieved the targeted goals for control of hyperglycemia, hypertension, and dyslipidemia, measured by glycosylated hemoglobin (HbA1c), systolic and diastolic blood pressure, and total serum cholesterol. The secondary objective was to assess the association of control of blood glucose, blood pressure, and blood lipids (3Bs) with hospital type (by geographic region and tier), clinic type (by physician specialty), patterns of

Study Design

The 3B STUDY was an observational, cross-sectional, multicenter, multispecialty study of ambulatory patients with established type 2 diabetes. Participants were enrolled at endocrinology, cardiology, nephrology, and internal medicine clinics in community hospitals (Tier 1), secondary/city level hospitals (Tier 2), and teaching or comprehensive central hospitals (Tier 3) across all major geographical regions in China.

The study was conducted according to the Good Clinical Practice and the

Results

A total of 25,817 patients with type 2 diabetes were enrolled between August 2010 and March 2011 from 104 hospitals by 730 investigators. Approximately 46%, 33%, 15%, and 6% of participating patients were enrolled from endocrinology, internal medicine, cardiology, and nephrology clinics, respectively; approximately 26%, 37%, and 37% of participating hospitals represented Tier 1, Tier 2, and Tier 3 hospitals, respectively. Detailed results about the association of hospital and clinic types with

Discussion

During the course of this study, the Chinese guidelines for prevention and treatment of type 2 diabetes were updated, including a change in target HbA1c levels from <6.5% to <7%.18, 19 Nearly half of the patients participating in this study reached the new target glycemic level (HbA1c <7.0%); this proportion is comparable to findings of previous studies conducted in other Asian countries.25 Moreover, almost a third of patients had an HbA1c level <6.5%. This finding represents a marked

Conclusion

Despite compelling evidence that achieving adequate control of blood pressure and lipids can significantly delay or prevent onset of cardiovascular disease in patients with diabetes, successful attainment of recommended therapeutic goals remains a global challenge. In light of the 3B STUDY results, 3B target levels may be considered as treatment goals for all diabetic patients, and patients should be actively assisted in their efforts to achieve integrated glycemic, blood pressure, and lipid

Acknowledgment

Authors of this manuscript would like to thank all CCMR-302-3B STUDY investigators (see the Appendix for a complete list of investigators) for their contribution to the successful completion of the 3B STUDY, and Dr Yuhui Zeng of VitalStrategic Research Institute for his assistance in preparing this manuscript.

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    Funding: This study was supported by an unrestricted grant offered by Merck Sharp & Dohme (China).

    Conflict of Interest: Investigators of this research received a modest fee to cover their clinical service, including laboratory tests, clinical work, and data collection and reporting. Investigators declare no other conflicts of financial interest for participation in this research.

    Authorship: All authors had access to the data and played a role in writing this article.

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