Study Quantifies Life-Years Added from Meeting Treatment Goals in Type 2 Diabetes

Hui Shao, MD, PhD

Achieving treatment goals could extend life expectancy by more than a decade among adults with type 2 diabetes.

Using data from more than 400 patients and a diabetes-specific microsimulation model, investigators from the University of Florida determined those in the lowest population quartile for BMI, HbA1c, systolic blood pressure, and LDL-C experience life expectancy gains of 3.9, 3.8, 1.9, and 0.9 years, respectively, when compared to their counterparts in the highest quartile for each category.

“This study quantified the potential gains in LE associated with different levels of biomarkers in patients with diabetes. Differences in HbA1c and BMI were found to have the strongest association with LE gain from a population perspective,” wrote investigators.

As diagnoses of type 2 diabetes become more commonplace despite increasing prevention efforts, the research focus for many has shifted to potential avenues for improving quality of life and life expectancy among these patients. With this in mind, a team from the University of Florida led by Hui Shao, MD, PhD, used the Building, Relating, Assessing, and Validating Outcomes (BRAVO) diabetes model to quantify to potential gains in life expectancy from achieving different target levels for HbA1c, systolic blood pressure, LDL-C, and BMI in patients with type 2 diabetes.

Designed using data from the ACCORD trial, the BRAVO diabetes model is a discrete-time patient-level microsimulation model that leverages a patient’s risk profile to project long-term health outcomes. For the current study, investigators calibrated the model using data from NHANES linked with short-term mortality data from the National Death Index.

From the 2015-2016 NHANES survey cycle, investigators identified 421 patients representative of the US adult type 2 diabetes population for inclusion in their analysis. This sample had a mean age of 65 (SD, 8.9) years and 46% were women. Patients within the cohort were grouped into quartiles based on HbA1c, systolic blood pressure, LDL-C, and BMI.

HbA1c quartiles were defined as less than 6.4%, 6.4-7.2%, 7.3-8.2%, and greater than 8.2%. Systolic blood pressure quartiles were defined as less than 122 mmHg, 122-132 mmHg, 133-144 mmHg, greater than 144 mmHg. LDL-C quartiles were defined as less than 73 mg/dL, 73-96 mg/dL, 97-122 mg/dL, greater than 122 mg/dL. BMI quartiles were defined as less than 27, 27-31, 32-36, and greater than 36 kg/m2.

Compared to those in the highest quartile of BMI, those in the first, second, and third quartiles of BMI had 3.9, 2.9, and 2.0 years of additional life expectancy, respectively. Compared to those in the highest quartile of systolic blood pressure, those in the first, second, and third quartiles of systolic blood pressure had 1.9, 1.5, and 1.1 years of additional life expectancy, respectively. Compared to those in the highest quartile of LDL-C, those in the first, second, and third-lowest quartiles of LDL-C gained 0.9, 0.7, and 0.5 years of additional life expectancy, respectively.

When assessing the life expectancy based on HbA1c levels, results indicated those in the third quartile had an additional 3.4 years in life expectancy compared to those in the highest quartile of HbA1c, but further reduction to the second quartile was only associated with a mean of 0.5 years of life expectancy gained. Further analysis demonstrated reduction to the lowest quartile was not associated with any additional gains of life expectancy, with those in the lowest quartile gaining 3.8 additional years of life expectancy compared to those in the highest quartile of HbA1c.

“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,” wrote investigators.

This study, “Potential Gains in Life Expectancy Associated With Achieving Treatment Goals in US Adults With Type 2 Diabetes,” was published in JAMA Network Open.