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RESEARCH PRODUCT
Clinical profiles and quality of care of subjects with type 2 diabetes according to their cardiovascular risk: an observational, retrospective study
Gabriella PiscitelliBasilio PintaudiAntonio NicolucciDomenico ManninoCorrao SalvatoreValeria ManicardiVera FrisonPaolo Di BartoloMaria Chiara RossiMarco GalloGiusi GrazianoAlessia Scatenasubject
AdultBlood GlucoseMalelcsh:Diseases of the circulatory (Cardiovascular) systemmedicine.medical_specialtyTime FactorsEndocrinology Diabetes and MetabolismType 2 diabetesIncretinsRisk AssessmentDiabetes mellitusInternal medicinemedicineElectronic Health RecordsHumansHypoglycemic AgentsMedical prescriptionSodium-Glucose Transporter 2 InhibitorsOriginal InvestigationAgedQuality Indicators Health CareRetrospective StudiesAngiologyCardiovascular risk Humans Hypoglycemic Agents Incretins Italy Male Middle Aged Retrospective Studies Risk Assessment Sodium-Glucose Transporter 2 Inhibitors Time Factors Treatment Outcome Quality Indicators Health Care Quality of care Type 2 diabetes Adult Aged Aged 80 and over Biomarkers Blood Glucose Cardiovascular Diseases Diabetes Mellitus Type 2 Dipeptidyl-Peptidase IV Inhibitors Heart Disease Risk Factors Female Electronic Health RecordsAged 80 and overDipeptidyl-Peptidase IV Inhibitorsbusiness.industryMedical recordQuality of careType 2 diabetesRetrospective cohort studyMiddle AgedCardiovascular riskmedicine.diseaseTreatment OutcomeDiabetes Mellitus Type 2ItalyCardiovascular DiseasesHeart Disease Risk Factorslcsh:RC666-701AlbuminuriaFemaleObservational studymedicine.symptomCardiology and Cardiovascular MedicinebusinessBiomarkersdescription
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.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2021-03-01 | Cardiovascular Diabetology |