Predictors of Adherence to American Diabetes Association Clinical Guidelines

Purpose: To examine the relationship between patient characteristics and adherence to American Diabetes Association (ADA) guidelines among participants with type 1 diabetes (T1D) from the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study. Methods: Medical history was collected by questionnaire (receiving endocrinologist care, glucose self-monitoring, education level, health insurance and medication) and blood samples were collected on 516 T1D participants. ADA clinical recommendations were used to evaluate health outcomes: HbA1c ≤ 7.0%, LDL cholesterol <100mg/dl and blood pressure (BP) ≤130/80mm Hg. Results: Guidelines were met by 24% of participants for HbA1c, 72% for LDL, and 67% for BP. Higher number of endocrinologist visits over the past year (OR=1.10, 95%CI 1.01-1.2; p=0.02), more frequent glucose self-monitoring (OR=1.25, 1.14-1.37; p<0.001) and longer diabetes duration (OR=1.04, 1.01-1.07; p=0.03) were independently associated with meeting HbA1c goals. Female gender (OR=1.63, 1.07-2.49, p=0.02) and statin medication use (OR=2.76, 1.75-3.25; p<0.001) were associated with meeting LDL goals. Female gender (OR=3.81, 2.50-5.80; p<0.001) and greater than a high school education (OR 2.19,1.21-4.00; p=0.01) were associated with meeting BP goals. Higher HbA1c was associated with lower odds of meeting LDL (OR=0.80, 0.67-0.96; p=0.01) and BP goals (OR=0.79, 0.33-1.88; p=0.008). Analysis adjusted for race, age, and health insurance status. Conclusions: More frequent endocrinologist visits and increased glucose self-monitoring appear to aid in better glycemic control which, in turn, is associated with better LDL and BP. While a cause-effect relationship cannot be established in this cross-sectional study, men and those with less education may need additional help meeting the LDL and BP guidelines.