Basilio Pintaudi1, Alessia Scatena2, Gabriella Piscitelli3, Vera Frison4, Salvatore Corrao5, Valeria Manicardi6, Giusi Graziano7, Maria Chiara Rossi7, Marco Gallo8, Domenico Mannino9, Paolo Di Bartolo10, Antonio Nicolucci11. 1. Diabetes Unit, Niguarda Cà Granda Hospital, Milan, Italy. 2. San Donato Hospital, Arezzo, Italy. 3. Diabetology, ASST Nord Milan, Sesto San Giovanni, Italy. 4. Internal Medicine and Diabetology Service, ULSS6, Cittadella, Italy. 5. Department of Internal Medicine, ARNAS Civico Benfratelli Hospital, University of Palermo, Palermo, Italy. 6. Diabetes Clinic, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy. 7. Center for Outcomes Research and Clinical Epidemiology, CORESEARCH, Corso Umberto I, 65122, Pescara, Italy. 8. AOU Città Della Salute E Della Scienza, Presidio Ospedaliero Molinette, Torino, Italy. 9. Endocrinology and Metabolic Unit, GOM, Reggio Calabria, Italy. 10. AUSL Diabetes Unit Romagna, Ravenna, Italy. 11. Center for Outcomes Research and Clinical Epidemiology, CORESEARCH, Corso Umberto I, 65122, Pescara, Italy. nicolucci@coresearch.it.
Abstract
BACKGROUND: 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. METHODS: The 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. RESULTS: Overall, 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. CONCLUSIONS: A 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.
BACKGROUND: 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. METHODS: The 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. RESULTS: Overall, 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. CONCLUSIONS: A 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.
Entities:
Keywords:
Cardiovascular risk; Quality of care; Type 2 diabetes
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