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 (HbA 1c), 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 HbA 1c, 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 HbA 1c (<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 (HbA 1c), 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 HbA 1c, 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 HbA 1c (<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
SN - 2044-6055
VL - 8
JO - BMJ Open
JF - BMJ Open
IS - 3
M1 - e019214
ER -
