The association between glycemic, lipids and blood pressure control among Israeli diabetic patients

Background: It is recommended that in diabetes mellitus patients all risk factors for cardiovascular disease should be controlled. Aim: To evaluate the rate of reaching all glycemic, lipids and blood pressure target levels among diabetic patients in Israel and to analyze demographic and clinical parameters associated with it. Design: A cross-sectional study. Methods: The study was conducted in Maccabi Healthcare Services, Israels second largest health maintenance organization. All patients (n = 41 936), older than 20 years, who were listed on Maccabi Healthcare Services diabetes mellitus computerized database and had all three study parameters (HbA1c, LDL-C and blood pressure levels during 2005) were eligible for the study. The rate of reaching HbA1c 7.0, LDL-C 100 mg/dl and blood pressure 130/85 mmHg, as well as its association with various demographic and clinical parameters were analyzed. Results: Only 13 of all study patients achieved all three target levels. The parameters which were significantly associated with goal achievement were compliance to medical treatment for all three parameters (OR 1.56, 95 CI 1.44-1.69, P = 0.0001), male gender (OR 1.42, 95 CI 1.31-1.54, P = 0.0001), comorbidity with ischemic heart disease (OR 1.23, 95 CI 1.13-1.34, P = 0.0001), and > 12 visits per year to family physician (OR 1.10, 95 CI 1.021.19, P = 0.012). Conclusion: Non-compliance with treatment and sub-optimal follow-up by family physicians are associated with increased risk of failure to control major risk factor among diabetic patients.