Abstract
BackgroundThe 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.MethodsA 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.ResultsIn 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.ConclusionsAmong 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.
Highlights
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
Patients were categorized by haemoglobin A1c (HbA1c) below or above 7% (53 mmol/mol) and 7.5% (58 mmol/ mol) consistently over 1 and 2 years post diagnosis to identify poor glycaemic control
Among patients without history of any CVD (n = 93,522), a delay in treatment intensification by 12 months [in conjunction with poor HbA1c level above 7% (53 mmol/mol)] was associated with significantly increased risks for myocardial infarction (MI), heart failure (HF), stroke and composite CVE by 80% (HR confidence interval (CI): 1.45, 2.22), 63% (HR CI: 1.36, 1.96), 50% (HR CI: 1.22, 1.84) and 64% (HR CI: 1.45, 1.85), respectively
Summary
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. The risk of cardiovascular complications has been related to glycaemia in patients with type 2 diabetes mellitus (T2DM). Randomised controlled trials have conclusively demonstrated that the risk of microvascular complications can be reduced by intensive glycaemic control in patients with T2DM [2–4]. There are controversies regarding the benefits of intensive glucose control [HbA1c
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