scholarly journals Change in cardiovascular risk factors following early diagnosis of type 2 diabetes: a cohort analysis of a cluster-randomised trial

2014 ◽  
Vol 64 (621) ◽  
pp. e208-e216 ◽  
Author(s):  
James A Black ◽  
Stephen J Sharp ◽  
Nicholas J Wareham ◽  
Annelli Sandbæk ◽  
Guy EHM Rutten ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Cardiovascular Risk ◽  
Early Diagnosis ◽  
Cardiovascular Risk Factors ◽  
Cohort Analysis ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Cluster Randomised

scholarly journals Effects of an electronic software ‘prompt’ with healthcare professional training on cardiovascular and renal complications in a multi-ethnic population with Type 2 Diabetes and Microalbuminuria (The GP Prompt study): results of a pragmatic cluster randomised trial.

2020 ◽  
Author(s):  
Andrew Willis ◽  
Winston Crasto ◽  
Laura J Gray ◽  
Helen Dallosso ◽  
Ghazala Waheed ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Cardiovascular Risk ◽  
Odds Ratio ◽  
Cardiovascular Events ◽  
Primary Outcome ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Cluster Randomised

<b>Background:</b> Tight, targeted control of modifiable cardiovascular risk factors can reduce cardiovascular complications and mortality in individuals with type 2 diabetes (T2DM) and microalbuminuria. The effects of using an electronic “Prompt” with a treatment algorithm to support a treat-to-target approach has not been tested in primary care. <p><b>Methods:</b> A multi-centre, cluster-randomised trial among primary care practices across Leicestershire, UK. Primary outcome was proportion of individuals achieving systolic and diastolic blood pressure (<130 and <80mmHg, respectively) and total cholesterol (<3.5mmol/l) targets at 24 months. Secondary outcomes included proportion of individuals with HbA1c<58 mmol/mol (<7.5%), changes in prescribing, change in albumin-creatinine ratio, major adverse cardiovascular events, cardiovascular mortality and coding accuracy.</p> <p><b>Results:</b> 2721 individuals from 22 practices, mean age 63 years, 41% female, 62% from Black and Minority Ethnic groups, completed two years follow-up. There were no significant differences in the proportion of individuals achieving the composite primary outcome, although the proportion of individuals achieving the pre-specified outcome of total cholesterol <4.0 mmol (Odds Ratio 1.24(1.05,1.47),p=0.01) increased with intensive intervention compared to control. Coding for microalbuminuria increased relative to control (Odds Ratio 2.05 (1.29, 3.25), p< 0.01]).</p> <p><b>Conclusions:</b> Greater improvements in composite cardiovascular risk factor control with this intervention compared to standard care were not achieved in this cohort of high-risk individuals with T2DM. However, improvements in lipid profile and coding can benefit patients with diabetes to alter the high risk of atherosclerotic cardiovascular events. Future studies should consider comprehensive strategies including patient education and healthcare professional engagement, in the management of T2DM.</p> <p><b> </b></p>

scholarly journals Effects of an electronic software ‘prompt’ with healthcare professional training on cardiovascular and renal complications in a multi-ethnic population with Type 2 Diabetes and Microalbuminuria (The GP Prompt study): results of a pragmatic cluster randomised trial.

2020 ◽  
Author(s):  
Andrew Willis ◽  
Winston Crasto ◽  
Laura J Gray ◽  
Helen Dallosso ◽  
Ghazala Waheed ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Cardiovascular Risk ◽  
Odds Ratio ◽  
Cardiovascular Events ◽  
Primary Outcome ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Cluster Randomised

<b>Background:</b> Tight, targeted control of modifiable cardiovascular risk factors can reduce cardiovascular complications and mortality in individuals with type 2 diabetes (T2DM) and microalbuminuria. The effects of using an electronic “Prompt” with a treatment algorithm to support a treat-to-target approach has not been tested in primary care. <p><b>Methods:</b> A multi-centre, cluster-randomised trial among primary care practices across Leicestershire, UK. Primary outcome was proportion of individuals achieving systolic and diastolic blood pressure (<130 and <80mmHg, respectively) and total cholesterol (<3.5mmol/l) targets at 24 months. Secondary outcomes included proportion of individuals with HbA1c<58 mmol/mol (<7.5%), changes in prescribing, change in albumin-creatinine ratio, major adverse cardiovascular events, cardiovascular mortality and coding accuracy.</p> <p><b>Results:</b> 2721 individuals from 22 practices, mean age 63 years, 41% female, 62% from Black and Minority Ethnic groups, completed two years follow-up. There were no significant differences in the proportion of individuals achieving the composite primary outcome, although the proportion of individuals achieving the pre-specified outcome of total cholesterol <4.0 mmol (Odds Ratio 1.24(1.05,1.47),p=0.01) increased with intensive intervention compared to control. Coding for microalbuminuria increased relative to control (Odds Ratio 2.05 (1.29, 3.25), p< 0.01]).</p> <p><b>Conclusions:</b> Greater improvements in composite cardiovascular risk factor control with this intervention compared to standard care were not achieved in this cohort of high-risk individuals with T2DM. However, improvements in lipid profile and coding can benefit patients with diabetes to alter the high risk of atherosclerotic cardiovascular events. Future studies should consider comprehensive strategies including patient education and healthcare professional engagement, in the management of T2DM.</p> <p><b> </b></p>

CONTROL OF CARDIOVASCULAR RISK FACTORS IN THE VETERANS AFFAIRS DIABETES TRIAL IN ADVANCED TYPE 2 DIABETES

2006 ◽  
Vol 12 (Supplement 1) ◽  
pp. 85-88 ◽  
Author(s):  
William C. Duckworth ◽  
Madeline McCarren ◽  
Carlos Abraira ◽  
VADT Investigators
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Veterans Affairs

scholarly journals Clinical profiles and quality of care of subjects with type 2 diabetes according to their cardiovascular risk: an observational, retrospective study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Basilio Pintaudi ◽  
Alessia Scatena ◽  
Gabriella Piscitelli ◽  
Vera Frison ◽  
Salvatore Corrao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Quality Of Care ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Cardiovascular Risk Factors ◽  
High Cardiovascular Risk ◽  
Very High

Abstract Background The European Society of Cardiology (ESC) recently defined cardiovascular risk classes for subjects with diabetes. Aim of this study was to explore the distribution of subjects with type 2 diabetes (T2D) by cardiovascular risk groups according to the ESC classification and to describe the quality indicators of care, with particular regard to cardiovascular risk factors. Methods The study is based on data extracted from electronic medical records of patients treated at the 258 Italian diabetes centers participating in the AMD Annals initiative. Patients with T2D were stratified by cardiovascular risk. General descriptive indicators, measures of intermediate outcomes, intensity/appropriateness of pharmacological treatment for diabetes and cardiovascular risk factors, presence of other complications and overall quality of care were evaluated. Results Overall, 473,740 subjects with type 2 diabetes (78.5% at very high cardiovascular risk, 20.9% at high risk and 0.6% at moderate risk) were evaluated. Among people with T2D at very high risk: 26.4% had retinopathy, 39.5% had albuminuria, 18.7% had a previous major cardiovascular event, 39.0% had organ damage, 89.1% had three or more risk factors. The use of DPP4-i markedly increased as cardiovascular risk increased. The prescription of secretagogues also increased and that of GLP1-RAs tended to increase. The use of SGLT2-i was still limited, and only slightly higher in subjects with very high cardiovascular risk. The overall quality of care, as summarized by the Q score, tended to be lower as the level of cardiovascular risk increased. Conclusions A large proportion of subjects with T2D is at high or very high risk. Glucose-lowering drug therapies seem not to be adequately used with respect to their potential advantages in terms of cardiovascular risk reduction. Several actions are necessary to improve the quality of care.

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