GLYCEMIC CONTROL AND CARDIOVASCULAR OUTCOMES IN DIABETIC PATIENTS: A PRIMARY CARE SETTING STUDY

Introduction: Type 2 diabetes mellitus is a growing health crisis in India, with cardiovascular disease as a leading cause of morbidity and mortality. This study investigated the relationship between glycemic control and cardiovascular outcomes in patients with type 2 diabetes managed in primary care settings. Methods: A prospective cross sectional study was conducted across a network of primary care centers. 1,200 adults with type 2 diabetes were followed for 6 months. Glycemic control was categorized based on HbA1c levels. Cox proportional hazards models assessed the relationship between glycemic control and cardiovascular events. Logistic regression identified factors associated with achieving glycemic targets. Results: Only 27% of patients achieved the target HbA1c of <7.0%. Patients with poor glycemic control (HbA1c ≥9.0%) had a nearly three-fold higher risk of cardiovascular events compared to those with well-controlled diabetes (HR 2.87, 95% CI 1.71-4.82, p<0.001). Factors associated with better glycemic control included older age, female gender, shorter diabetes duration, lower BMI, high medication adherence, metformin use, and regular physical activity. Low medication adherence was associated with a three-fold increase in cardiovascular risk compared to high adherence. Conclusion: This study highlights the significant association between glycemic control and cardiovascular outcomes in primary care settings. The findings underscore the need for comprehensive, patient-centered approaches to diabetes management that address multiple risk factors and barriers to care, particularly medication adherence.