title: Novel determinants preventing achievement of major cardiovascular targets in type 2 diabetes.
abstract: BACKGROUND
  T2DM management requires tight control of 3 critical quality indicators to prevent vascular complications: LDL-C, SBP, and HbA1c. This study evaluated the rate of T2DM patients attaining these critical quality indicators, and the pathophysiological or cardiometabolic traits predicting goal achievement.
  
  
  METHODS
  Cross-sectional analysis evaluating combined goal achievement (LDL-C<100 mg/dL; SBP<130 mmHg and HbA1c<7.0%) in 1005 T2DM outpatients (654 men) followed in a university hospital multidisciplinary department. Triple-goal achievers were compared to non-achievers regarding sociodemographics; anthropometrics; homeostatic model assessment (HOMA; β-cell function (B); insulin sensitivity (S); hyperbolic product (B×S)); CV and glucose-lowering drugs; micro-/macro-vascular outcomes; and 10-year UKPDS risk.
  
  
  RESULTS
  Eighty-eight patients (9%; ((3 targets) group) reached all goals, whereas 917 patients (91%; ((0-2 target(s)) group) missed 1, 2 or all 3 goals. Compared to (0-2 target(s)), (3 targets) had shorter diabetes duration; less familial diabetes history; lower waist/visceral fat; higher β-cell function and hyperbolic product (B×S); lower (B×S) loss rate and less metabolic syndrome (all p<0.05). They had lower apoB and triglycerides; and a 28% prevalence of atherogenic dyslipidemia (vs. 40% in (0-2 target(s)); p 0.0398). Microangiopathy (36% vs. 53%) and 10-year CAD risk (13% vs. 18%) were also significantly lower in (3 targets).
  
  
  CONCLUSIONS
  The subset of T2DM patients achieving all critical quality indicators are characterized by a less severe cardiometabolic phenotype, while exhibiting a less pronounced alteration of their residual β-cell function. These differences are related to fewer microvascular outcomes and lower 10-year CV risk.
authors.affiliation: Ecole de Santé Publique, Faculté de Médecine, Université Libre de Bruxelles, Belgium.
authors.forename: Soumaïla
authors.initials: S
authors.lastname: Camara
authors.affiliation: Service de Maladies Métaboliques et Endocriniennes, Centre Hospitalier et Universitaire de Brazzaville, Congo.
authors.forename: Evariste
authors.initials: E
authors.lastname: Bouenizabila
authors.affiliation: Division of Endocrinology & Nutrition, Cliniques universitaires St-Luc and Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium. Electronic address: michel.hermans@diab.ucl.ac.be.
authors.forename: Michel P
authors.initials: MP
authors.lastname: Hermans
authors.affiliation: Division of Cardiology, Cliniques universitaires St-Luc and Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium.
authors.forename: Sylvie A
authors.initials: SA
authors.lastname: Ahn
authors.affiliation: Division of Cardiology, Cliniques universitaires St-Luc and Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium.
authors.forename: Michel F
authors.initials: MF
authors.lastname: Rousseau
mesh_terms: D000368:Aged; D001530:Belgium / Q000453:epidemiology; D015415:Biomarkers / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000378:metabolism / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000378:metabolism* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000378:metabolism / Q000517:prevention & control*; D050171:Dyslipidemias / Q000378:metabolism* / Q000503:physiopathology; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D050417:Insulin-Secreting Cells / Q000378:metabolism*; D008875:Middle Aged; D010641:Phenotype; D015995:Prevalence; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Glycated haemoglobin; LDL-cholesterol; Microangiopathy; Quality of care; Systolic blood pressure; Type 2 diabetes mellitus