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Regular testing for HbA1c, lipids and microalbuminuria may prevent diabetes complications
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Among employees at a large manufacturing company who also had diabetes, those who were monitored for HbA1c, lipids and microalbuminuria experienced fewer diabetes complications than those who did not, according to a recent study.
The retrospective cohort study studied administrative data on 1,797 employees with diabetes who worked for a large US-based manufacturing company with consistent health care benefits in 22 states. The researchers defined quality of care as undergoing the following three tests: HbA1C tests for glycated hemoglobin, lipid tests, and urine screening for microalbuminuria. Workers who received all three of these measures of care starting in the baseline year of 2003 were compared with employees who received less comprehensive care. A multivariate model accounted for possible confounders such as baseline age, gender, ethnicity, marital status, income, insulin use, comorbidities and smoking status.
The study evaluated the correlations between the three measure of care and time to event for four major diabetes complications: coronary artery disease, stroke, heart failure and renal disease. The participants were observed from 2003 to 2009.
The researchers found that for heart failure (HR=0.39; 95% CI, 0.19-0.81) and renal disease (HR=0.48; 95% CI, 0.24-0.95), the disparities between the two groups in time to progression were significant. Those who received the three care measures also were found to be at lower risk for developing any of the four complications (HR=0.66; 95% CI, 0.48-0.91). Although differences in time to complication for CAD and stroke also showed trends toward significance, they did not achieve statistical significance.
Of particular interest, according to the researchers, was that those in the group receiving the three care measures were actually more unhealthy at baseline than those who did not.
“It is noteworthy that in the primary test of the hypothesis, the baseline characteristics created an uneven playing field, with more ostensibly sick patients having a higher rate of better care,” the researchers wrote. “Thus, the deck was stacked against those with better care having better outcomes, an effect that began to be visually apparent in the third observation year.”
Disclosure: Bayer reports employment with Alcoa Aluminum, who provided data for this study.
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