Meeting Biomarker Treatment Goals in T2D Can Add Years in Life Expectancy, Study Finds

Among patients with type 2 diabetes (T2D), achieving treatment goals is likely to extend life expectancy (LE), according to new research published in JAMA Network Open.

Individuals with T2D have a higher risk of premature death, due in large part to increased risks of macrovascular and microvascular complications, authors explained, while studies have shown that in comparison with healthy individuals aged 50, having the disease is associated with a 6-year LE loss.

However, improved control of blood pressure, glucose, cholesterol level, and body weight may reduce the risk of complications and could extend LE.

“Quantifying life-years gained from better diabetes care is imperative in clinical practice and designing public health interventions,” the authors wrote, adding “clinicians can use this information in the shared decision-making process with their patients, emphasizing the benefit of diabetes care in prolonging life expectancy.”

To better understand US lifetime projections of individuals with T2D, investigators employed the Building, Relating, Assessing, and Validating Outcomes (BRAVO) diabetes model, which uses data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial.

Specifically, the researchers assessed patients’ current risk profiles to project long-term health outcomes. All individuals enrolled in ACCORD between 2001 and 2009 had T2D and elevated risks of cardiovascular complications.

In addition, “to calibrate the BRAVO model for the general US population, we built a calibration sample from the 2009-2010 National Health and Nutrition Examination Survey (NHANES) and linked mortality records from the National Death Index,” the authors wrote.

A total of 421 individuals (46% women) from the NHANES with T2D were included in the analysis; their mean (SD) age was 65.6 (8.9) years. Participants were categorized into quartiles based on glycated hemoglobin (A_1C), systolic blood pressure (SBP), body mass index (BMI), and low-density lipoprotein cholesterol (LDL-C).

Analyses revealed:

• 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
• Compared with an SBP of 160.4 mm Hg (fourth), lower SBPs of 114.1 (first), 128.2 (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
• Lower LDL-C levels of 59 (first), 84.0 (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)
• Reducing A_1C from 9.9% (fourth) to 7.7% (third) was associated with a 3.4-year gain in LE
• A further reduction in A_1C to 6.8% (second) was associated with only a mean of 0.5 years gained in LE, and from 6.8% to 5.9% (first) was not associated with LE benefit
• Reducing A_1C from the fourth quartile to the first is associated with an LE gain of 3.8 years

From a population perspective, data showing differences in A_1C and BMI yielded the strongest association with LE gain, while at the individual level, variations were seen in benefits associated with better diabetes care and patients’ individual characteristics.

“The benefit of biomarker control was most pronounced in younger adults and diminished as people aged. Better control of biomarkers can potentially increase the LE by 3 years in an average person with T2D in the US,” the authors added.

For those with high A_1C, SBP, LDL-C, and BMI, adequate control of these biomarkers may increase LE by over 10 years. Although LE gained through lower BMI was the largest among the modifiable biomarkers, this benefit may not be easily achieved in clinical practice, the researchers cautioned. However, patients may still be able to achieve half of the goal in optimal BMI and gain a substantial proportion of LE benefit.

Sodium-glucose cotransporter 2 inhibitors were not included in the ACCORD trial, marking a limitation to the study. In addition, findings are limited to projection accuracy of the BRAVO model, which did not include additional potential risk factors like triglyceride levels or end-stage kidney disease.

“Our findings can be used by clinicians and patients in selecting optimal treatment goals, to motivate patients in achieving them, and to measure potential health benefits for interventions and programs to improve diabetes care in the US,” the researchers concluded.

Reference

Kianmehr H, Zhang P, Luo J, et al. Potential gains in life expectancy associated with achieving treatment goals in US adults with type 2 diabetes. JAMA Netw Open. Published online April 18, 2022. doi:10.1001/jamanetworkopen.2022.7705