The Adherence of Primary Care Providers to the cardiovascular protection in patients with the debut of Type 2 Diabetes Mellitus.

Abstract

BackgroundThe major cause of death in patients with T2DM is major adverse negative cardiovascular events, consequently, hypoglycemic therapy with a cardioprotective effect has an advantage over other oral hypoglycemic agents. Primary care providers often demonstrate clinical inertia in managing patients with the onset of T2DM, underestimating their cardiovascular risk. ObjectiveTo evaluate adherence to ADA diabetes care standards in patients with high and low cardiovascular risk and newly diagnosed T2DM.Methods We conducted a retrospective study of medical records of patients with newly diagnosed T2DM. The subject of the study was medical records, according to which the cardiovascular risk of patients was calculated using ASCVD 2013 Risk Calculator from AHA/ACC. The patients were divided into 2 groups: low risk (ASCVD <7.5%) and high risk (ASCVD ≥ 7.5%). We used the definitions of the ADA 2021 standards for diabetes management processes and goals to assess glucose-lowering therapy.Results One hundred medical from primary care centers in Karaganda, Kazakhstan were selected for analysis. The average age of patients at the time of diagnosis is 50.7 years. The average HbA1C level is 7.2%. The level of systolic blood pressure is 131 mm Hg, diastolic - 85 mm Hg. The mean total cholesterol level is 5.8 mmol/l. The overall adherence of physicians to ADA standards prescribing glucose-lowering agents is 82.97%. In the high cardiovascular risk group adherence is 76.6%, in the low-risk group - 93.5% (chi-square 20.447, p = 0.039). ConclusionWe found suboptimal adherence to ADA standards for diabetes management among patients at high cardiovascular risk at the onset with type 2 diabetes.