![]() Quantifying life-years gained from better diabetes care is imperative in clinical practice and designing public health interventions. ![]() A reduction of glycated hemoglobin (HbA 1c to convert to proportion of total hemoglobin, multiply by 0.01) from 8% to 6% was estimated to increase 1.2 life-years in women aged 55, but this benefit was much smaller in women in their 70s (0.8 life-years). 9 - 11 The benefit from better management of glucose, blood pressure, cholesterol, and body weight is also associated with age and health conditions. 6 - 8 Other studies also found that lowering blood pressure among individuals with T2D could lead to a longer LE. 3 - 5 Several studies have shown that higher body weight was associated with a substantial loss in LE. 2 Better control of blood pressure, glucose and cholesterol levels, and body weight in people with T2D can potentially reduce the risk of diabetes-related complications and mortality, thus extending LE. 1 Compared with people without T2D at the age of 50, having T2D is associated with a life expectancy (LE) loss of 6 years. People with type 2 diabetes (T2D) have increased risks of macrovascular and microvascular complications, which lead to an escalated risk of premature death. Overall, reducing HbA 1c from the fourth quartile to the first is associated with an LE gain of 3.8 years.Ĭonclusions and Relevance These findings can be used by clinicians to motivate patients in achieving the recommended treatment goals and to help prioritize interventions and programs to improve diabetes care in the US. However, a further reduction to 6.8% (second) was associated with only a mean of 0.5 years gain in LE, and from 6.8% to 5.9% (first) was not associated with LE benefit. Reducing HbA 1c from 9.9% (fourth) to 7.7% (third) was associated with 3.4 years gain in LE. A lower LDL-C level of 59 mg/dL (first), 84.0 mg/dL (second), and 107.0 mg/dL (third) were associated with 0.9, 0.7, and 0.5 years gain in LE, compared with LDL-C of 146.2 mg/dL (fourth). Compared with an SBP of 160.4 mm Hg (fourth), lower SBP levels of 114.1 mm Hg (first), 128.2 mm Hg (second), and 139.1 mm Hg (third) were associated with 1.9, 1.5, and 1.1 years gained in LE in people with T2D, respectively. Compared with a BMI of 41.4 (mean of the fourth quartile), lower BMIs of 24.3 (first), 28.6 (second), and 33.0 (third) were associated with 3.9, 2.9, and 2.0 additional life-years, respectively, in people with T2D. Results Among 421 individuals, 194 (46%) were women, and the mean (SD) age was 65.6 (8.9) years. Main Outcomes and Measures Life expectancy. LE gains associated with achieving better control were estimated by moving people with T2D from the current quartile of each biomarker to the lower quartiles. Data were analyzed from January to October 2021.Įxposure The study population was grouped into quartiles on the basis of levels of HbA 1c, SBP, LDL-C, and BMI. The model was then used to conduct the simulation experiment on the study population over a lifetime. Objective To quantify potential gains in life expectancy (LE) among people with type 2 diabetes (T2D) associated with lowering glycated hemoglobin (HbA 1c), systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), and body mass index (BMI) toward optimal levels.ĭesign, Setting, and Participants In this decision analytical model, the Building, Relating, Assessing, and Validating Outcomes (BRAVO) diabetes microsimulation model was calibrated to a nationally representative sample of adults with T2D from the National Health and Nutrition Examination Survey (2015-2016) using their linked short-term mortality data from the National Death Index. The benefit of continually improving goal achievement has not been evaluated to date. Importance Improvements in control of factors associated with diabetes risk in the US have stalled and remain suboptimal.
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