Accumulation of risk factors among patients with type 2 diabetes

Abstract Background For effective type 2 diabetes (T2D) management, it is necessary to control risk factors (RFs), including hyperglycemia, dyslipidemia, obesity, hypertension, and smoking. This study aims to characterize patient groups based on presence of multiple RFs to assess the prevalence of patients in very high risk by using real-world data from primary health care of one wellbeing services county in Finland. Methods All patients with T2D diagnosis between 2013 and 2022 and who were alive at the end of 2024, were identified from the electronic health records (EHR) of the North Karelia region using the ICD-10 code E11 (n = 10420). Data on age, sex, glycated hemoglobin (HbA1c), low-density lipoprotein (LDL), body mass index (BMI), blood pressure (BP) and smoking were obtained from the EHR. The used target values were HbA1c <53 mmol/mol, LDL <2.6 mmol/mol, BMI <25 kg/m2, BP < 140/80 mmHg, and non-smoking. Accumulation of uncontrolled risk factors was assessed. Results Overall, HbA1c measurements were available for 89% of patients, LDL for 86%, BMI for 67%, and BP for 67%. Of the last measurements, within target were 67% of HbA1c, 84% of LDL, 16% of BMI, and 42% of BP. Smoking status was available for 67% of patients, and 85% were non-smokers. Measurement availability was lowest for men in the youngest age group (18-54 years) across the RFs. About 47% of the patients had at least 2 uncontrolled RFs. Only 20% of patients had all RFs adequately controlled. Better control for HbA1c and less smoking was found in women. BMI and BP were the least controlled RFs in both sexes and all age groups, particularly among those aged 18-54 and 55-64. Conclusions Measurement availability and target value achievement varied between sexes and different age groups. The prevalence of those with multiple uncontrolled RFs was high. The results highlight the need to focus more on young patients, particularly men. The results are expected to enhance clinical management of T2D in the region. Key messages • The study indicates notable evidence-treatment gaps in T2D patients, both in follow-up and risk factor control. • The accumulation of uncontrolled risk factors varies considerably by age and sex.