Suboptimal control of glycemia, blood pressure, and LDL cholesterol in overweight adults with diabetes: the Look AHEAD Study.
BACKGROUND
The characteristics associated with meeting goals for glycemia, blood pressure (BP), and low-density lipoprotein (LDL) cholesterol for participants with diabetes were examined.


METHODS
Baseline information on demographics, medical history, and anthropometry, as well as on hemoglobin A1c, BP, and LDL cholesterol levels, was measured in 5145 participants of Look AHEAD, a multicenter randomized trial performed to determine whether long-term weight loss and increased physical fitness reduce cardiovascular disease (CVD) in overweight and obese individuals with type 2 diabetes. Logistic regression was used to analyze these cross-sectional data to ascertain associations between participant characteristics and attainment of risk factor goals [hemoglobin A1c <7.0%, BP <130/80 mmHg, and LDL <100 mg/dl].


RESULTS
The study population had a mean age of 58.7 years and a mean body mass index of 36.0 kg/m(2). Of the total number of participants, 59.5% were female, 36.8% were of ethnic/racial minority, and 87.3% were on diabetes medications. Upon enrollment, 45.8% had hemoglobin A1c<7.0%, 51.7% had BP<130/80 mmHg, and 37.2% had LDL<100 mg/dl. All three goals were met by only 10.1%. We found consistent evidence for differences in risk factor control by age, gender, race/ethnicity, degree of obesity, education, income, CVD, source of medical care, and medication use. In multivariable analysis, African-American race, increasing degree of obesity, insulin use, and nonutilization of a lipid-lowering agent were associated with not meeting all risk factor goals.


CONCLUSIONS
These data demonstrate that numerous baseline characteristics are associated with suboptimal control of these cardiovascular risk factors among overweight and obese adults with diabetes.
Bertoni
Alain G
AG
Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA. abertoni@wfubmc.edu
Clark
Jeanne M
JM
Feeney
Patricia
P
Yanovski
Susan Z
SZ
Bantle
John
J
Montgomery
Brenda
B
Safford
Monika M
MM
Herman
William H
WH
Haffner
Steven
S
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000209:etiology; D008078:Cholesterol, LDL / Q000097:blood*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000208:ethnology / Q000378:metabolism*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006937:Hypercholesterolemia / Q000503:physiopathology / Q000628:therapy; D006943:Hyperglycemia / Q000503:physiopathology / Q000628:therapy; D006973:Hypertension / Q000503:physiopathology / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications* / Q000208:ethnology / Q000378:metabolism*; D010809:Physical Fitness / Q000502:physiology; D012307:Risk Factors; D015431:Weight Loss / Q000502:physiology
D001786:Blood Glucose; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin