RESEARCH ARTICLE SA JOURNAL OF DIABETES & VASCULAR DISEASE 22 VOLUME 21 NUMBER 1 • November 2024 Comprehensive ABC (HbA1c, blood pressure, LDL-C) control and cardiovascular disease risk in patients with type 2 diabetes mellitus and major depressive disorder in a South African managed healthcare organisation Abstract Aim: Patients with type 2 diabetes mellitus (T2DM) who have suboptimal control of the triad of glucose (A), blood pressure (B) and lipid profile (C) have an increased risk of cardiovascular disease (CVD). Additionally, the presence of major depressive disorder (MDD) can lead to poor outcomes. Therefore, the aim of this study was to assess the role of MDD with ABC control in patients with T2DM in a South African private healthcare setting. Methods: Healthcare medical claims and electronic health records of 1 211 adult patients with T2DM and/or MDD were analysed for 2019. Results: Only 24% of the T2DM +/– MDD patients reached a low-density lipoprotein cholesterol (LDL-C) target < 1.8 mmol/l, and only 13% of the T2DM + MDD and 7.1% of T2DM – MDD patients achieved simultaneous ABC targets. The proportion of patients admitted due to macrovascular complications was higher in the T2DM + MDD group (22.8%) compared to the T2DM – MDD (13.1%) andMDD group (9.9%) (p = 0.012). Multivariate logistic regression analysis showed that older patients with T2DM + MDD achieved better glycated haemoglobin and LDL-C control. Significantly more patients with T2DM + MDD (12%) had repeat macrovascular admissions in 2019 compared to the T2DM – MDD patients (2.9%) (p = 0.005). Conclusion: Despite a managed-care environment, the comprehensive ABC control among patients with T2DM was suboptimal, particularly in those with MDD, placing them at greater risk for CVD events. Keywords: type 2 diabetes mellitus (T2DM), major depressive disorder (MDD), cardiovascular disease (CVD), ABC control, glycated haemoglobin (HbA1c), systolic blood pressure (SBP), lowdensity lipoprotein cholesterol (LDL-C), managed healthcare Type 2 diabetes mellitus (T2DM) and major depressive disorder (MDD) are highly prevalent diseases in South Africa (SA),1,2 with co-morbid MDD presenting in 17% of patients with T2DM in a privately managed healthcare organisation.3 Claims data showed that more patients with T2DM and co-morbid MDD (T2DM + MDD) (73%) experienced hyperlipidaemia than those with T2DM (61%) alone (T2DM – MDD).3 T2DM is considered a cardiovascular (CV) risk equivalent.4 The ABC practice guidelines5 (glycated haemoglobin, blood pressure, low-density lipoprotein cholesterol) for atherosclerotic CV risk management indicate the evidence-based levels required to determine control of blood glucose, systolic blood pressure (SBP) and serum lipid levels to reduce the risk of atherosclerotic cardiovascular events.6-8 The ABC goals of T2DM were defined by South African diabetes guidelines6 as meeting glycated haemoglobin (HbA 1c) levels < 7%, SBP < 140 mmHg and diastolic blood pressure (DBP) < 90 mmHg, and low-density lipoprotein cholesterol (LDL-C) levels < 1.8 mmol/l. ABC is an abbreviation put together by the American Diabetes Association9 and the American College of Cardiology5 to bring awareness to the public. Poor ABC management in patients with T2DM results in a significant increase in the risk of cardiovascular disease (CVD) events such as myocardial infarctions, strokes and cardiac failure and mortality.10,11 The control of blood glucose is a fundamental goal in T2DM, with HbA1c level being the best marker of glucose levels and microvascular (nephropathy, retinopathy and neuropathy) outcomes.6 However, chronic hyperglycaemia is also an added risk factor for atherosclerosis in patients with T2DM. Atherosclerosis is often accelerated and severe in T2DM.6 Complex manifestation of atherogenic dyslipidaemia12 and significant alteration of circulating LDL-C level, a major determinant of atherosclerotic CV risk predisposed to coronary artery disease (CAD), occurs in T2DM over time.13 Hypertension, another vascular disease, affects people with T2DM during the course of their disease. They are then at a greater risk of developing target-organ damage than non-diabetics.14 The importance of achieving individual and composite three part (ABC) risk-factor control has been reported from the National Health Lovina A Naidoo, Neil Butkow, Paula Barnard-Ashton, Elena Libhaber Correspondence to: Lovina A Naidoo Neil Butkow Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa e-mail: lovina.naidoo@camaf.co.za Paula Barnard-Ashton School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Elena Libhaber Health Sciences Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Previously published online in Cardiovasc J Afr March 2024 S Afr J Diabetes Vasc Dis 2024; 21: 22–30
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