scholarly journals Trends in the Degree of Control and Treatment of Cardiovascular Risk Factors in People With Type 2 Diabetes in a Primary Care Setting in Catalonia During 2007–2018

2022 ◽  
Vol 12 ◽  
Author(s):  
Manel Mata-Cases ◽  
Bogdan Vlacho ◽  
Jordi Real ◽  
Ramon Puig-Treserra ◽  
Magdalena Bundó ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Cardiovascular Risk ◽  
Beta Blockers ◽  
Density Lipoprotein ◽  
Cross Sectional ◽  
Lipid Control

ObjectiveTo assess the trends in cardiovascular risk factor control and drug therapy from 2007 to 2018 in subjects with type 2 diabetes mellitus (T2DM).Materials and MethodsCross-sectional analysis using yearly clinical data and treatment obtained from the SIDIAP database. Patients aged ≥18 years with a diagnosis of T2DM seen in primary care in Catalonia, Spain. ResultsThe number of T2DM patients increased from 299,855 in 2007 to 394,266 in 2018. We also found an increasing prevalence of cardiovascular disease, heart failure, and chronic kidney disease (from 18.4 to 24.4%, from 4.5 to 7.3%, and from 20.2 to 31.3%, respectively). The achievement of glycemic targets (HbA1c<7%) scarcely changed (54.9% to 55.9%). Major improvements were seen in blood pressure (≤140/90 mmHg: from 55% to 71.8%), and in lipid control (low-density lipoprotein cholesterol <100 mg/dl: 33.4% to 48.4%), especially in people with established cardiovascular disease (48.8 to 69.7%). Simultaneous achievement of all three targets improved from 12.5% to 20.1% in the overall population and from 24.5% to 32.2% in those with cardiovascular disease but plateaued after 2013. There was an increase in the percentage of patients treated with any antidiabetic drug (70.1% to 81.0%), especially metformin (47.7% to 67.7%), and DPP4i (0 to 22.6%). The use of SGLT-2 and GLP-1ra increased over the years, but remained very low in 2018 (5.5% and 2.1% of subjects, respectively). There were also relevant increases in the use of statins (38.0% to 49.2%), renin-angiotensin system (RAS) drugs (52.5% to 57.2%), and beta-blockers (14.3% to 22.7%).ConclusionsDuring the 2007-2018 period, relevant improvements in blood pressure and lipid control occurred, especially in people with cardiovascular disease. Despite the increase in the use of antidiabetic and cardiovascular drugs, the proportion of patients in which the three objectives were simultaneously achieved is still insufficient and plateaued after 2013. The use of antidiabetic drugs with demonstrated cardio renal benefits (SGLT-2 and GLP-1ra) increased over the years, but their use remained quite low.

scholarly journals Appropriateness of aspirin prescribing for primary and secondary prevention of cardiovascular disease in type 2 diabetes in different care settings

2021 ◽  
Author(s):  
Shi Ying Tan ◽  
Heather Cronin ◽  
Stephen Byrne ◽  
Adrian O’Donovan ◽  
Antoinette Tuthill
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Primary Prevention ◽  
Secondary Prevention ◽  
Shared Care ◽  
University Hospital ◽  
Cross Sectional ◽  
Prevention Of Cardiovascular Disease

Abstract Background Type 2 diabetes is associated with an increased cardiovascular risk. Use of aspirin has been shown to be of benefit for secondary prevention of cardiovascular disease in patients with type 2 diabetes; benefits in primary prevention have not been clearly proven. Aims This study aims to (a) determine if aspirin is prescribed appropriately in type 2 diabetes for primary or secondary prevention of cardiovascular disease (CVD) and (b) evaluate whether there are differences in aspirin prescribing according to where people receive their care. Design Cross-sectional study Methods The medical records of individuals with type 2 diabetes aged over 18 years and attending Elmwood Primary Care Centre and Cork University Hospital Diabetes outpatient clinics (n = 400) between February and August 2017 were reviewed. Results There were 90 individuals exclusively attending primary care and 310 persons attending shared care. Overall, 49.0% (n = 196) of those were prescribed aspirin, of whom 42.3% were using it for secondary prevention. Aspirin was used significantly more in people attending shared care (p < 0.001). About 10.8% of individuals with diabetes and CVD attending shared care met guidelines for, but were not prescribed aspirin. Conclusion A significant number of people with type 2 diabetes who should have been prescribed aspirin for secondary prevention were not receiving it at the time of study assessment. In contrast, a substantial proportion who did not meet criteria for aspirin use was prescribed it for primary prevention.

scholarly journals Individualised risk prediction model for new-onset, progression and regression of chronic kidney disease in a retrospective cohort of patients with type 2 diabetes under primary care in Hong Kong

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e035308
Author(s):  
Lin Yang ◽  
Tsun Kit Chu ◽  
Jinxiao Lian ◽  
Cheuk Wai Lo ◽  
Shi Zhao ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Primary Care ◽  
Retrospective Cohort ◽  
Density Lipoprotein ◽  
Test Results ◽  
Health Records ◽  
Laboratory Test Results ◽  
New Onset

ObjectivesThis study is aimed to develop and validate a prediction model for multistate transitions across different stages of chronic kidney disease (CKD) in patients with type 2 diabetes mellitus under primary care.SettingWe retrieved the anonymised electronic health records of a population-based retrospective cohort in Hong Kong.ParticipantsA total of 26 197 patients were included in the analysis.Primary and secondary outcome measuresThe new-onset, progression and regression of CKD were defined by the transitions of four stages that were classified by combining glomerular filtration rate and urine albumin-to-creatinine ratio. We applied a multiscale multistate Poisson regression model to estimate the rates of the stage transitions by integrating the baseline demographic characteristics, routine laboratory test results and clinical data from electronic health records.ResultsDuring the mean follow-up time of 1.8 years, there were 2632 patients newly diagnosed with CKD, 1746 progressed to the next stage and 1971 regressed into an earlier stage. The models achieved the best performance in predicting the new-onset and progression with the predictors of sex, age, body mass index, systolic blood pressure, diastolic blood pressure, serum creatinine, haemoglobin A1c, total cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides and drug prescriptions.ConclusionsThis study demonstrated that individual risks of new-onset and progression of CKD can be predicted from the routine physical and laboratory test results. The individualised prediction curves developed from this study could potentially be applied to routine clinical practices, to facilitate clinical decision making, risk communications with patients and early interventions.

scholarly journals Cardiovascular Benefit of Empagliflozin Across the Spectrum of Cardiovascular Risk Factor Control in the EMPA-REG OUTCOME Trial

2020 ◽  
Vol 105 (9) ◽  
pp. 3025-3035
Author(s):  
Silvio E Inzucchi ◽  
Kamlesh Khunti ◽  
David H Fitchett ◽  
Christoph Wanner ◽  
Michaela Mattheus ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Density Lipoprotein ◽  
Baseline Risk ◽  
Risk Factor Control ◽  
Increased Risk ◽  
Outcome Trial

Abstract Context Control of multiple cardiovascular (CV) risk factors reduces CV events in individuals with type 2 diabetes. Objective To investigate this association in a contemporary clinical trial population, including how CV risk factor control affects the CV benefits of empagliflozin, a sodium-glucose cotransporter-2 inhibitor. Design Post hoc analysis. Setting Randomized CV outcome trial (EMPA-REG OUTCOME). Participants Type 2 diabetes patients with established CV disease. Intervention Empagliflozin or placebo. Main Outcome Measures Risk of CV outcomes—including the treatment effect of empagliflozin—by achieving 7 goals for CV risk factor control at baseline: (1) glycated hemoglobin &lt;7.5%, (2) low-density lipoprotein cholesterol &lt;100 mg/dL or statin use, (3) systolic blood pressure &lt;140 mmHg and diastolic blood pressure &lt;90 mmHg, (4) pharmacological renin-angiotensin-aldosterone system blockade, (5) normoalbuminuria, (6) aspirin use, (7) nonsmoking. Results In the placebo group, the hazard ratio (HR) for CV death was 4.00 (95% CI, 2.26–7.11) and 2.48 (95% CI, 1.52–4.06) for patients achieving only 0–3 or 4–5 risk factor goals at baseline, respectively, compared with those achieving 6–7 goals. Participants achieving 0–3 or 4–5 goals also had increased risk for the composite outcome of hospitalization for heart failure or CV death (excluding fatal stroke) (HR 2.89 [1.82–4.57] and 1.90 [1.31–2.78], respectively) and 3-point major adverse CV events (HR 2.21 [1.53–3.19] and 1.42 [1.06–1.89]). Empagliflozin significantly reduced these outcomes across all risk factor control categories (P &gt; 0.05 for treatment-by-subgroup interactions). Conclusions Cardiovascular risk in EMPA-REG OUTCOME was inversely associated with baseline CV risk factor control. Empagliflozin’s cardioprotective effect was consistent regardless of multiple baseline risk factor control.

Quality of Care in Patients with Type 2 Diabetes in Iran: A 5-year retrospective study

2019 ◽  
Author(s):  
yahya bayazidi ◽  
Majid Davari ◽  
Abbas Kebriaeezadeh ◽  
Bagher Larijani ◽  
Alireza Esteghamati ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Quality Of Care ◽  
Hemoglobin A1c ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Cross Sectional ◽  
Private And Public

Abstract Background The object of this study was to evaluate the quality of care indicators (process- and outcome-related) in patients with type 2 diabetes using patient-level data during the last 5 years in Iran, in private and public diabetes centers in five provinces (Tehran, Isfahan, Yazd, Mazandaran, and Kurdistan).Method Our study was a cross-sectional study carried out on patients with type 2 diabetes at 13 diabetes centers (private and public). Annual tests for hemoglobin A1C, serum lipid (LDL) and screening for nephropathy (urine protein or urine albumin quantitative test) were used to evaluate process-related and hemoglobin A1C, blood pressure and lipids levels were used to assess outcome-related outcomes.Findings Among 1976 patients, 54% were women with an average of 15 years of diabetes duration and approximately 83% of patients were obese or overweight. About 9% of patients had a hemoglobin A1C test every three months. The values obtained were favorable for controlling lipid profile but less than standard for screening for nephropathy and only about 30% of patients were within the optimal range for simultaneous control of process-related indicators. Findings for outcome- related indicators show that the achievement of blood glucose, blood pressure, and low-density lipoprotein targets were 31, 49 and 70%, respectively and concurrent achievement was 13.8% in the last year.Conclusion The performance of the health system has much room for improvement and diabetes control programs have not been favorable in any of the provinces studied and have not led to optimal control.

scholarly journals Prevalence and coprevalence of chronic comorbid conditions in patients with type 2 diabetes in Catalonia: a population-based cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e031281 ◽  
Author(s):  
Manel Mata-Cases ◽  
Josep Franch-Nadal ◽  
Jordi Real ◽  
Marta Cedenilla ◽  
Didac Mauricio
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Chronic Conditions ◽  
Cross Sectional Study ◽  
Secondary Outcome ◽  
Sectional Study ◽  
Cross Sectional

ObjectivesTo evaluate the prevalence and coprevalence of several chronic conditions in patients with type 2 diabetes in a Mediterranean region.DesignA cross-sectional study.SettingTwo hundred and eighty-six primary care teams of the Catalonian Health Institute (Catalonia, Spain).ParticipantsWe included patients aged ≥18 years with a diagnosis of type 2 diabetes by 31 December, 2016, who were registered in the Information System for the Development of Research in primary care (SIDIAP) database. We excluded patients with a diagnosis of type 1 diabetes, gestational diabetes mellitus and any other type of diabetes.Primary and secondary outcome measuresWe collected data on diabetes-related comorbidities (ie, chronic complications, associated cardiovascular risk factors and treatment complications). Diagnoses were based on the International Classification of Diseases, 10thRevision codes recorded in the database or, for some entities, on the cut-off points for a particular test result or a specific treatment indicated for that entity. The presence and stage of chronic kidney disease (CKD) were based on the glomerular filtration rate, the CKD Epidemiology Collaboration creatinine equation and the urine albumin-to-creatinine ratio.ResultsA total of 373 185 patients were analysed. 82% of patients exhibited ≥2 comorbidities and 31% exhibited ≥4 comorbidities. The most frequent comorbidities were hypertension (72%), hyperlipidaemia (60%), obesity (45%), CKD (33%), chronic renal failure (CRF)(28%) and cardiovascular disease (23%). The most frequently coprevalent pairs of chronic conditions were the combination of hypertension with hyperlipidaemia (45%), obesity (35%), CKD (28%), CRF (25%) or cardiovascular disease (19%), as well as the combination of hyperlipidaemia with obesity (28%), CKD (21%), CRF (18%) or cardiovascular disease (15%); other common pairs of comorbidities were obesity/CKD, obesity/CRF, hypertension/retinopathy, hypertension/albuminuria, hypertension/urinary tract infection, CVD/CRF and CVD/CKD, which were each present in more than 10% of patients.ConclusionPatients with type 2 diabetes have a high frequency of coprevalence of metabolic risk factors, cardiovascular disease and CKD and thus require an integrated management approach.

scholarly journals Impact of multimorbidity on healthcare professional task shifting potential in patients with type 2 diabetes in primary care: a French cross-sectional study

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e016545 ◽  
Author(s):  
Irène Supper ◽  
Yann Bourgueil ◽  
René Ecochard ◽  
Laurent Letrilliart
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Primary Care ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Healthcare Professionals ◽  
Health Problems ◽  
Cross Sectional ◽  
Allied Healthcare

ObjectivesTo estimate the transferability of processes of care from general practitioners (GPs) to allied healthcare professionals and the determinants of such transferability.DesignFrench national cross-sectional multicentre studySetting128 family practices providing supervised training for residents in general practice.ParticipantsAll patients consulting with their GP over a total number of 20 days (ie, 1 day a week from December 2011 to April 2012). Encounters where type 2 diabetes was one of the managed health problems were selected for analysis.Primary and secondary outcome measuresProcesses that were associated with specific health problems were collected by 54 residents. Potential process transferability was the main outcome assessed, as well as the professionals involved in the collaboration and the eventual conditions associated with transfer.ResultsFrom 8572 processes of care that concerned 1088 encounters of patients with diabetes, 21.9% (95% CI 21.1% to 22.8%) were considered eligible for transfer from GPs to allied healthcare professionals (78.1% to nurses, 36.7% to pharmacists). Processes were transferable with condition(s) for 70.6% (ie, a protocol, shared record or supervision). The most transferable processes concerned health maintenance (32.1%) and cardiovascular risk factors (hypertension (28.7%), dyslipidaemia (25.3%) and diabetes (24.3%)). Multivariate analysis showed that educational processes or a long-term condition status were associated with increased transferability (OR 3.26 and 1.47, respectively), whereas patients with higher intellectual occupations or those with two or more associated health problems were associated with lower transferability (OR 0.33 and 0.81, respectively).ConclusionsA significant part of GP activity relating to patients with multimorbidity including type 2 diabetes could be transferred to allied healthcare professionals, mainly on prevention and global education to cardiovascular risk factors. The organisational and finance conditions of team work as views of patients and healthcare professionals must be explored before implementation in primary care.

scholarly journals Russian multicentre type 2 diabetes screening program in patients with cardiovascular disease

2016 ◽  
Vol 19 (1) ◽  
pp. 24-29 ◽  
Author(s):  
Marina Vladimirovna Shestakova ◽  
Irina Evgenievna Chazova ◽  
Ekaterina Alekseevna Shestakova
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Glucose Tolerance ◽  
Screening Program ◽  
Density Lipoprotein ◽  
High Risk Group ◽  
Oral Glucose ◽  
Screening Programs

Aim.To evaluate the prevalence of undiagnosed type 2 diabetes mellitus (T2DM) among patients with cardiovascular disease.Materials and methods.T2DM screening programs among patients with cardiovascular disease were held from 2013 to 2014 in several Russian cities. In total, 1001 patients aged ≥40 years with hypertension and/or atherosclerotic disease and without prior diagnosis of T2DM were screened in outpatient cardiology clinics. T2DM diagnosis was based on fasting plasma glucose levels, glycated haemoglobin (HbA1c) and/or oral glucose tolerance test (OGTT) results. Blood pressure (BP), family history of T2DM, cardiovascular disease, total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglyceride levels were analysed.Results.Fasting glucose was measured in 1000 (99.8%) patients, HbA1c was measured in in 623 (62.2%) and OGTT was performed in 286 (2.6%). Fasting glucose detected 8% of newly diagnosed T2DM; among patients who underwentHbA1c measurement, the prevalence of T2DM was 10.91%, and among patients who underwent OGTT, the prevalence was 13.99%. Depending on the chosen test, the prevalence of undiagnosed pre-diabetes (impaired fasting glycaemia and impaired glucose tolerance) was in the range of 14.4%–36.4%. The majority of patients with T2DM diagnosed by OGTT did not have target blood pressure and lipid levels; 67.5% had elevated systolic BP, 47.5% had elevated diastolic BP, 90.9% had high LDL (≥1.8 mmol/l) and 52.9% had high triglyceride levels (≥1.7 mmol/l).Conclusion.A high prevalence of undiagnosed T2DM (from 8% to 13.99%, depending on the diagnostic criteria) and pre-diabetic state in patients with cardiovascular disease may require screening for T2DM in this high-risk group.

scholarly journals Fatores Associados a Tensão Arterial Não Controlada em Pessoas com Diabetes Tipo 2 Seguidas nos Cuidados de Saúde Primários em Portugal

2017 ◽  
Vol 30 (3) ◽  
pp. 197 ◽  
Author(s):  
Inês Rosendo ◽  
Luiz Miguel Santiago ◽  
Margarida Marques
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Primary Care ◽  
Regression Analysis ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Primary Care Patients

Introduction: Determine whether socio-demographic, habits and risk factors are associated with a better tensional control in type 2 diabetes in primary care patients in order to identify a specific target population for compensatory interventions improving diabetes control and reducing its morbi-mortality.Material and Methods: Cross-sectional study in primary care. Randomized type 2 diabetes patient data collection by their volunteer family doctors, proportionally stratified from the 5 Portuguese continental regions. Variables: blood pressure, age, gender, education, diabetes duration, HbA1c, smoking habits, weight, waist circumference, physical activity and adherence to medication. Bivariate and logistic regression analysis to evaluate each measured variable’s independent association with uncontrolled blood pressure (≥ 140/90).Results: 709 patients were included in the study, 60.2% men, mean age 66.12 ± 10.47 years. In logistic regression analysis, the factors independently associated to uncontrolled BP were lower education (p = 0.014), shorter diabetes duration (p = 0.002), higher waist circumference (p < 0.001), higher pulse pressure (p < 0.001), higher physical activity level (p = 0.043) and being a smoker (p < 0.001).Discussion: The main limitations are the fact that the sample was not totaly random and included only primary care patients, a possible inter-observer bias and being a cross-sectional study, thus not providing information on temporal relation or causality.Conclusion: The sub-group of people with diabetes identified to have worse tensional control should have a different and more intensive approach in primary care. We recommend further longitudinal and population based confirmatory research.

scholarly journals CONSENSUS STATEMENT BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY ON THE COMPREHENSIVE TYPE 2 DIABETES MANAGEMENT ALGORITHM – 2020 EXECUTIVE SUMMARY

2020 ◽  
Vol 26 (1) ◽  
pp. 107-139 ◽  
Author(s):  
Alan J. Garber ◽  
Yehuda Handelsman ◽  
George Grunberger ◽  
Daniel Einhorn ◽  
Martin J. Abrahamson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Cardiovascular Risk ◽  
American Association ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Angiotensin Ii Receptor Blocker ◽  
Low Density

Abbreviations: A1C = hemoglobin A1C; AACE = American Association of Clinical Endocrinologists; ABCD = adiposity-based chronic disease; ACCORD = Action to Control Cardiovascular Risk in Diabetes; ACCORD BP = Action to Control Cardiovascular Risk in Diabetes Blood Pressure; ACE = American College of Endocrinology; ACEI = angiotensin-converting enzyme inhibitor; AGI = alpha-glucosidase inhibitor; apo B = apolipoprotein B; ARB = angiotensin II receptor blocker; ASCVD = atherosclerotic cardiovascular disease; BAS = bile acid sequestrant; BMI = body mass index; BP = blood pressure; CCB = calcium channel blocker; CGM = continuous glucose monitoring; CHD = coronary heart disease; CKD = chronic kidney disease; DKA = diabetic ketoacidosis; DPP4 = dipeptidyl peptidase 4; eGFR = estimated glomerular filtration rate; EPA = eicosapentaenoic acid; ER = extended release; FDA = Food and Drug Administration; GLP1 = glucagon-like peptide 1; HDL-C = high-density-lipoprotein cholesterol; HeFH = heterozygous familial hypercholesterolemia; LDL-C = low-density-lipoprotein cholesterol; LDL-P = low-density-lipoprotein particle; Look AHEAD = Look Action for Health in Diabetes; NPH = neutral protamine Hagedorn; OSA = obstructive sleep apnea; PCSK9 = proprotein convertase subtilisin-kexin type 9 serine protease; RCT = randomized controlled trial; SU = sulfonylurea; SGLT2 = sodium-glucose cotransporter 2; SMBG = self-monitoring of blood glucose; T2D = type 2 diabetes; TZD = thiazolidinedione

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