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Impact of a multifactorial treatment programme on clinical outcomes and cardiovascular risk estimates : A retrospective cohort study from a specialised diabetes centre in Denmark

Safai, Narges; Carstensen, Bendix; Vestergaard, Henrik and Ridderstråle, Martin LU (2018) In BMJ Open 8(3).
Abstract

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... (More)

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.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
CVD risk, glycaemic control, multifactorial treatment, outcomes, type 2 diabetes
in
BMJ Open
volume
8
issue
3
publisher
British Medical Journal Publishing Group
external identifiers
  • scopus:85044180161
ISSN
2044-6055
DOI
10.1136/bmjopen-2017-019214
language
English
LU publication?
yes
id
7f781303-a3ae-4ab7-aef9-e14b69ce418e
date added to LUP
2018-04-06 08:11:32
date last changed
2018-07-07 03:00:10
@article{7f781303-a3ae-4ab7-aef9-e14b69ce418e,
  abstract     = {<p>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&lt;0.0001). The proportion of patients who met the treatment goal for HbA 1c (&lt;7% (&lt;53 mmol/mol)) increased from 31% to 58% (p&lt;0.0001); for BP (&lt;130/80 mm Hg) from 24% to 34% (p&lt;0.0001), and for LDL cholesterol (&lt;2.5 mmol/L (patients without previous CVD) or &lt;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&lt;0.0001), and when relaxing the BP target to &lt;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.</p>},
  articleno    = {e019214},
  author       = {Safai, Narges and Carstensen, Bendix and Vestergaard, Henrik and Ridderstråle, Martin},
  issn         = {2044-6055},
  keyword      = {CVD risk,glycaemic control,multifactorial treatment,outcomes,type 2 diabetes},
  language     = {eng},
  month        = {03},
  number       = {3},
  publisher    = {British Medical Journal Publishing Group},
  series       = {BMJ Open},
  title        = {Impact of a multifactorial treatment programme on clinical outcomes and cardiovascular risk estimates : A retrospective cohort study from a specialised diabetes centre in Denmark},
  url          = {http://dx.doi.org/10.1136/bmjopen-2017-019214},
  volume       = {8},
  year         = {2018},
}