TY - JOUR

T1 - Impact of a multifactorial treatment programme on clinical outcomes and cardiovascular risk estimates

T2 - a retrospective cohort study from a specialised diabetes centre in Denmark

AU - Safai, Narges

AU - Carstensen, Bendix

AU - Vestergaard, Henrik

AU - Ridderstråle, Martin

N1 - © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

PY - 2018/3/1

Y1 - 2018/3/1

N2 - OBJECTIVES: To investigate the impact of a multifactorial treatment programme in a real-life setting on clinical outcomes and estimated cardiovascular disease (CVD) risk.DESIGN: A retrospective observational cohort study, using data from the electronic medical records and national registers.SETTING: Tertiary diabetes centre in Denmark.PARTICIPANTS: Patients with type 2 diabetes (n=4299) referred to a programme with focus on treatment of hyperglycaemia, hypertension and dyslipidaemia between 1 January 2001 and 1 April 2016.OUTCOMES: Primary outcomes were changes in haemoglobin A1c (HbA1c), blood pressure (BP) and low-density lipoprotein (LDL) cholesterol as well as proportion reaching treatment targets. Our secondary outcome was to investigate changes in antidiabetic, antihypertensive and lipid-lowering treatment, together with the impact on estimated CVD risk. Linear mixed model for repeated measurements were used for continuous variables and logistic regression for dichotomous variables.RESULTS: The patients achieved a mean±SD decrease in HbA1c, systolic and diastolic BP and LDL cholesterol of 1.0%±0.04% (10.6±0.4 mmol/mol), 6.3±0.4 mm Hg, 2.7±0.2 mm Hg and 0.32±0.02 mmol/L, respectively (p<0.0001). The proportion of patients who met the treatment goal for HbA1c (<7% (<53 mmol/mol)) increased from 31% to 58% (p<0.0001); for BP (<130/80 mm Hg) from 24% to 34% (p<0.0001), and for LDL cholesterol (<2.5 mmol/L (patients without previous CVD) or <1.8 mmol/L (patients with previous CVD)) from 52% to 65%. Those reaching all three guideline treatment targets increased from 4% to 15% (p<0.0001), and when relaxing the BP target to <140/85 from 8% to 24%. The estimated CVD risk was relatively reduced by 15.2% using the Swedish National Diabetes Register risk engine and 30.9% using the UK Prospective Diabetes Study risk engine.CONCLUSIONS: Our data support that short-term multifactorial treatment of patients with glycaemic dysregulation in a specialist outpatient setting is both achievable and effective, and associated with a clinically meaningful improvement in CVD risk.

AB - OBJECTIVES: To investigate the impact of a multifactorial treatment programme in a real-life setting on clinical outcomes and estimated cardiovascular disease (CVD) risk.DESIGN: A retrospective observational cohort study, using data from the electronic medical records and national registers.SETTING: Tertiary diabetes centre in Denmark.PARTICIPANTS: Patients with type 2 diabetes (n=4299) referred to a programme with focus on treatment of hyperglycaemia, hypertension and dyslipidaemia between 1 January 2001 and 1 April 2016.OUTCOMES: Primary outcomes were changes in haemoglobin A1c (HbA1c), blood pressure (BP) and low-density lipoprotein (LDL) cholesterol as well as proportion reaching treatment targets. Our secondary outcome was to investigate changes in antidiabetic, antihypertensive and lipid-lowering treatment, together with the impact on estimated CVD risk. Linear mixed model for repeated measurements were used for continuous variables and logistic regression for dichotomous variables.RESULTS: The patients achieved a mean±SD decrease in HbA1c, systolic and diastolic BP and LDL cholesterol of 1.0%±0.04% (10.6±0.4 mmol/mol), 6.3±0.4 mm Hg, 2.7±0.2 mm Hg and 0.32±0.02 mmol/L, respectively (p<0.0001). The proportion of patients who met the treatment goal for HbA1c (<7% (<53 mmol/mol)) increased from 31% to 58% (p<0.0001); for BP (<130/80 mm Hg) from 24% to 34% (p<0.0001), and for LDL cholesterol (<2.5 mmol/L (patients without previous CVD) or <1.8 mmol/L (patients with previous CVD)) from 52% to 65%. Those reaching all three guideline treatment targets increased from 4% to 15% (p<0.0001), and when relaxing the BP target to <140/85 from 8% to 24%. The estimated CVD risk was relatively reduced by 15.2% using the Swedish National Diabetes Register risk engine and 30.9% using the UK Prospective Diabetes Study risk engine.CONCLUSIONS: Our data support that short-term multifactorial treatment of patients with glycaemic dysregulation in a specialist outpatient setting is both achievable and effective, and associated with a clinically meaningful improvement in CVD risk.

KW - Adult

KW - Aged

KW - Antihypertensive Agents/therapeutic use

KW - Blood Glucose/analysis

KW - Blood Pressure/physiology

KW - Cardiovascular Diseases/blood

KW - Cholesterol/blood

KW - Denmark

KW - Diabetes Mellitus, Type 2/complications

KW - Dyslipidemias/drug therapy

KW - Female

KW - Glycated Hemoglobin A/analysis

KW - Humans

KW - Hypertension/drug therapy

KW - Hypoglycemic Agents/therapeutic use

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Prospective Studies

KW - Retrospective Studies

KW - Risk Factors

U2 - 10.1136/bmjopen-2017-019214

DO - 10.1136/bmjopen-2017-019214

M3 - Journal article

C2 - 29550776

VL - 8

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 3

M1 - e019214

ER -