Achievement of individualized treatment targets in patients with comorbid type-2 diabetes and hypertension: 6 months results of the DIALOGUE registry.
BACKGROUND
Patients with type-2 diabetes mellitus (T2DM) and hypertension have increased risk of cardiovascular disease (CVD). We studied individualized treatment targets and their achievement in clinical practice.


METHODS
DIALOGUE is a prospective, multi-center registry in patients with both T2DM and hypertension.


RESULTS
Patients (n = 6,586) had a baseline fasting glucose (8.5 ± 2.8 mmol/l), postprandial glucose (10.9 ± 3.4 mmol/l), and HbA1c (7.8 ± 2.1%) levels indicated poor glycemic control. Baseline systolic and diastolic BP were 140.3 ± 15.7 and 82.6 ± 9.5, respectively. Patients were categorized by HbA1c treatment goals: ≤6.5% (strict), >6.5 to ≤7.0% (medium), and >7.0 to ≤7.5% (loose). When considering systolic BP (SBP) targets (≤130 mmHg [strict], >130 to ≤135 mmHg [medium], and >135 to ≤140 mmHg [loose]), patients with strict SBP treatment goals displayed similar characteristics to those with strict HbA1c targets. Although approximately 70% of patients received both strict HbA1c and SBP targeting, overall treatment goals remained unmet in all HbA1c target groups at the 6-month follow-up. SBP targets were not reached in the strict and medium groups, but were achieved in the loose treatment group. Specific predictors for choosing loose SBP or HbA1c treatment goals were identified, including SBP/HbA1c levels and various comorbidities.


CONCLUSIONS
Individualized glucose and BP targets were selected by treating physicians based on patient characteristics and overall comorbidity. While treatment goals were not consistently met using various antidiabetic and antihypertensive therapies, our analyses indicated that the strictly targeted patient populations maintained lower overall HbA1c and SBP levels at 6 months.
Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany. roland.schmieder@uk-erlangen.de.
Roland E
RE
Schmieder
Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany. gitta@klilu.de.|Medizinische Klinik B, Herzzentrum Ludwigshafen, Ludwigshafen, Germany. gitta@klilu.de.
Anselm K
AK
Gitt
Novartis Pharma GmbH, Nürnberg, Germany. cornelia.koch@novartis.com.
Cornelia
C
Koch
Institut für Pharmakologie und Präventive Medizin, Mahlow, Germany. peter.bramlage@ippmed.de.
Peter
P
Bramlage
Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany. ouarrak@ihf.de.
Taoufik
T
Ouarrak
Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany. diethelm.tschoepe@ruhr-uni-bochum.de.|Stiftung "Der herzkranke Diabetiker" in der Deutschen Diabetes-Stiftung, Georgstrasse 11, 32545, Bad Oeynhausen, Germany. diethelm.tschoepe@ruhr-uni-bochum.de.
Diethelm
D
Tschöpe
D000124:Achievement; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006040:Goals; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012042:Registries