Abstract 14786: Disparities in Composite Cardiovascular Risk Factor Control in US Adults With Diabetes in the NIH Precision Medicine Initiative All of Us Research Program

Background/Objective: There are limited contemporary data in real-world populations on composite cardiovascular risk factor (RF) control in adults with diabetes mellitus (DM). We studied the proportions of patients with DM at target for individual and multiple cardiovascular RFs including HbA1c, LDL-C, BMI, blood pressure, and smoking status.

Methods: We included adults ≥18 years of age with DM from the NIH Precision Medicine Initiative All of Us Research Program 2018-2022. RFs and target values were defined as 1) HbA1c (<7% w/ atherosclerotic cardiovascular disease (ASCVD) or <8% w/o ASCVD), 2) LDL-C (<55mg/dL w/ ASCVD or <70mg/dL w/o ASCVD), 3) blood pressure (<130/80 mmHg), 4) BMI (<25 kg/m ² ), and 5) smoking status (never or former smoker). We investigated the proportion (%) of patients at target for individual RFs, ≥3 RFs, ≥4 RFs, and mean number at target by sex, race/ethnicity, and ASCVD status.

Results: Individual and composite cardiovascular RF control was found to be low among the 83,093 participants with DM. Control of

3 RFs and ≥ 4 RFs was only 25% and 5% overall, respectively, with fewer than 1% at target for all 5 RFs; female sex, Asian race/ethnicity, and those with prior ASCVD were more likely to have multiple RFs at target. Non-Hispanic black participants had the lowest proportion of RFs at target. In a multiple logistic regression, higher income, higher education level, employment, female sex, and Non-Hispanic White & Asian race/ethnicity positively predicted control of ≥ 4 RFs with p-value < 0.001.

Conclusions: Individual and composite RF control remains suboptimal in many patients with DM, with disparities across certain demographic subsets. Further efforts are required to address social determinants that may be responsible for continuing gaps in adequate RF control and to educate clinicians and patients on the importance of controlling key RFs that impact ASCVD and other outcomes in those with DM.