Delay in treatment intensification increases the risks of cardiovascular events in patients with type 2 diabetes

Cardiovascular Diabetology

Kamlesh Khunti¹  Michael L Wolden²  Brian L Thorsted²  Kerenaftali Klein³  Sanjoy K Paul³ 

[1] Leicester Diabetes Centre, University of Leicester, Leicester, UK;Novo Nordisk A/S, Vandtårnsvej, Denmark;Clinical Trials and Biostatistics Unit, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Brisbane 4006, QLD, Australia

关键词: Clinical inertia;    Longitudinal analysis;    Cardiovascular risk;    Delay in treatment intensification;    Type 2 diabetes;   

Others  :  1223754
DOI  :  10.1186/s12933-015-0260-x

 received in 2015-06-18, accepted in 2015-07-18,  发布年份 2015

【 摘 要 】

Background

The aim of the study was to evaluate the effect of delay in treatment intensification (IT; clinical inertia) in conjunction with glycaemic burden on the risk of macrovascular events (CVE) in type 2 diabetes (T2DM) patients.

Methods

A retrospective cohort study was carried out using United Kingdom Clinical Practice Research Datalink, including T2DM patients diagnosed from 1990 with follow-up data available until 2012.

Results

In the cohort of 105,477 patients mean HbA1c was 8.1% (65 mmol/mol) at diagnosis, 11% had a history of cardiovascular disease, and 7.1% experienced at least one CVE during 5.3 years of median follow-up. In patients with HbA1c consistently above 7/7.5% (53/58 mmol/mol, n = 23,101/11,281) during 2 years post diagnosis, 26/22% never received any IT. Compared to patients with HbA1c <7% (<53 mmol/mol), in patients with HbA1c ≥7% (≥53 mmol/mol), a 1 year delay in receiving IT was associated with significantly increased risk of MI, stroke, HF and composite CVE by 67% (HR CI: 1.39, 2.01), 51% (HR CI: 1.25, 1.83), 64% (HR CI: 1.40, 1.91) and 62% (HR CI: 1.46, 1.80) respectively. One year delay in IT in interaction with HbA1c above 7.5% (58 mmol/mol) was also associated with similar increased risk of CVE.

Conclusions

Among patients with newly diagnosed T2DM, 22% remained under poor glycaemic control over 2 years, and 26% never received IT. Delay in IT by 1 year in conjunction with poor glycaemic control significantly increased the risk of MI, HF, stroke and composite CVE.

【 授权许可】

   
2015 Paul et al.

【 图 表 】

Fig.1.

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