Mortality associated with less intense risk-factor control among adults with diabetes in the United States.

Aims: Determine the mortality experience among adults with diabetes in meeting and not meeting less intense control for glycated hemoglobin (HbA1c), blood pressure (BP), and cholesterol.

Methods: National Health and Nutrition Examination Survey 1999-2010 participants with self-report of diagnosed diabetes (N=3335), measured HbA1c, BP and non-HDL cholesterol were linked to the National Death Index through December 31, 2011. Proportional hazards models were used to estimate hazard ratios (HR) of meeting HbA1c<9% and BP<160/110, and non-HDL cholesterol<190mg/dL. Models used age as the time scale and adjusted for demographics (sex, race/ethnicity, education), diabetes duration, history of cardiovascular and chronic kidney disease, and treatments for elevated glucose, BP, and cholesterol.

Results: Over a mean 5.4 person-years of follow-up, participants meeting all less intense control had a 37% lower mortality (HR=0.63, 95% CI 0.54, 0.74) relative to those who did not meet the goals. Of approximately 306,000 deaths per year that occur among Americans with diabetes, we estimate 39,400 might have been averted by improving the care of those who have not met these less intense control goals.

Conclusions: Meeting the less intense control goals is associated with 37% reduction in mortality and could lead to 39,400 fewer deaths per year.