Delay in treatment intensification increases the risks of cardiovascular events in patients with type 2 diabetes

• DOI: 10.1186/s12933-015-0260-x
• Publication Date: 2015-08-06T08:58:27Z
• Authors: Sanjoy K Paul; Kerenaftali Klein; Brian L Thorsted; Michael L Wolden; Kamlesh Khunti
• Keywords: Blood Glucose; Male; 0301 basic medicine; glomerulus filtration rate; Time Factors; Databases, Factual; Delay in treatment intensification; Endocrinology, Diabetes and Metabolism; autofluorescence; vascular surgery; advanced glycation end product; non invasive procedure; Abstracts; 0302 clinical medicine; pericytes; mesenchimal stem cells; microvesicles; diabetes; cardiovascular disease; Risk Factors; diabetic patient; Preventive Health Services; gender; rank sum test; oxidative stress; angiography; hemoglobin A1c; risk; Original Investigation; hypercholesterolemia; Longitudinal analysis; blood pressure; Type 2 diabetes; 600; Middle Aged; cerebrovascular disease; 3. Good health; comorbidity; female; risk factor; Cardiovascular Diseases; diabetes mellitus; Drug Therapy, Combination; Female; patient; Cardiology and Cardiovascular Medicine; coronary artery disease; cardiovascular risk; analysis of variance; skin; hypertension; 610; Risk Assessment; smoking; Time-to-Treatment; Student t test; 03 medical and health sciences; male; 616; cross-sectional study; Humans; Hypoglycemic Agents; tissues; human; antilipemic agent; Aged; Retrospective Studies; Glycated Hemoglobin; model; Primary Health Care; echography; outpatient department; case control study; Cardiovascular risk; logistic regression analysis; mortality; abdominal aorta aneurysm; Clinical inertia; confidence interval; Diabetes Mellitus, Type 2; glycemic control; prognosis; atherosclerosis; chronic kidney disease; Biomarkers; peripheral occlusive artery disease; chi square test

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.A 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.In 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.Among 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.