MON-166 Excess Cardiovascular Events Despite Good Glycaemic Control

Abstract

The Royal Australasian College of General Practitioners (RACGP) have published standards of care for patients with type II diabetes. Data from rural Australia are limited. In the light of recent trials such as EMPA-REG standards of care in routine clinical practice in regional Queensland were compared to RACGP standards and the presence of cardiovascular complications noted. Methods: We retrospectively analyzed data from 258 patients in a single, primary care setting in regional Queensland, Australia. Data were collected for glycaemic control, lipids, BMI,blood pressure, lipids, microalbuminuria and presence of cardiovascular complications. In total 258 patients were identified. The average BMI was 32.4 kg/m2, age 63, 120 female, 138 male. Only 3 smoked but 67 (25%) consumed more than 2 standard drinks per day. Average BP was 136/81 though 42% exceeded the systolic BP target of 140 mmHg and 19% exceeded the diastolic target of 90 mmHg. Average HbA1c achieved was 6.8% with 53% at or below the target of 7%. Average total cholesterol was 4.4 (170), HDL 1.2 (46), LDL 2.3 (89) and triglyceride 2.0 (77) mmol/L (mg/dL). Microalbumin was elevated in 20% of female and 40% of male subjects. The prevalence of ischaemic heart disease was 25%, cerebrovascular disease 5%, peripheral vascular disease 6% and chronic kidney disease 7%. The majority were treated with sulphonylureas, metformin and insulin with relatively little use of SGLT2 inhibitors or GLP1 analogues. Glycaemic control was better than reported in the Australian National Diabetes Audit (ANDA) (HbA1c 8.1%). Smoking rates were low however blood pressure targets were often not met. Females suffered 26% of IHD burden, compared to 2% in the general female population aged 45-54. The prevalence of microalbuminuria in male subjects is twice the typical rate for Australia. In summary, despite achieving target levels of glycaemic control or exceeding them, there remains a high burden of cardiovascular complications when diabetes is treated with traditional agents. Ischaemic heart disease in female patients and microalbuminuria in male subjects may be suitable targets for SGLT2 inhibition given the published evidence of benefits. We intend to repeat our survey after a targeted intervention in these areas of interest.