Abstract
BackgroundThe 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.MethodsThe 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.ResultsOverall, 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.ConclusionsA 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.
Highlights
The European Society of Cardiology (ESC) recently defined cardiovascular risk classes for subjects with diabetes
When subjects were stratified according to their cardiovascular risk, 78.5% of them were at very high risk, 20.9% at high risk and 0.6% at moderate risk
The class of moderate risk was small. It included subjects with a low mean age and a short diabetes duration; a quarter of subjects were newly-diagnosed; Body Mass Index (BMI) levels were significantly lower than the other risk classes
Summary
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. Patients with T2D have a significant increase in the risk of coronary heart disease and ischemic stroke and a 1.5 to 3.6 fold. Diabetes is an important risk factor for heart failure, peripheral artery disease, and microvascular complications, negatively impacting quality of life and life expectancy. Great advances in prevention and therapy have resulted in significant reductions in diabetes-related cardiovascular mortality, cardiovascular risk still remains high in most patients with diabetes. Recent evidence indicates that the cardiovascular risk in T2D is highly heterogeneous, being it not universally similar to the risk of patients with previous cardiovascular disease [5,6,7,8]
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