Management outcomes of patients with type 2 diabetes: targeting the 10-year absolute risk of coronary heart disease.
OBJECTIVE
To assess the management of patients with type 2 diabetes mellitus in the primary care setting, with respect to risk factors associated with coronary heart disease.


METHODS
Retrospective cross-sectional audit.


METHODS
Specialised diabetes assessment clinic in a tertiary referral teaching hospital.


METHODS
328 patients with type 2 diabetes mellitus (mean age, 58.3 years [95% CI, 57.5-59.1]) and no existing coronary heart disease (CHD) referred to the clinic by general practitioners during 2004-2005.


METHODS
Comparison of glycated haemoglobin (HbA(1c)), systolic blood pressure and total cholesterol levels and smoking frequency with current RACGP (Royal Australian College of General Practitioners) targets (< 7.0%; < 130/80 mmHg; < 4 mmol/L; and smoking cessation, respectively). Estimation of patients' 10-year absolute risk of CHD events using the United Kingdom Prospective Diabetes Study risk engine, and its relation to primary prevention of CHD.


RESULTS
42%, 61% and 43% of patients were receiving medication to treat hyperglycaemia, hypertension and hypercholesterolaemia, respectively; 46%, 29% and 15% of patients, respectively, had [corrected] achieved the recommended RACGP target values for HbA1c, blood pressure, and total cholesterol; and 22% of patients were current smokers. The mean 10-year absolute risk of CHD was 16.8% (95% CI, 15.7%-17.9%), and 48% of patients were classified as "high risk" (absolute risk, > 15%). Based on the 10-year absolute risk, there was no difference between high- and low-risk groups with respect to prescription of aspirin, statins or angiotensin-converting enzyme inhibitors. If all the recommended RACGP goals were achieved, the mean 10-year absolute risk would decrease to 12.6% (95% CI, 11.8%-13.4%).


CONCLUSIONS
Recommended treatment targets are not being uniformly achieved. Medication for primary CHD prevention is not being preferentially directed at those patients at highest risk, based on the estimated 10-year absolute risk of CHD events. Our findings suggest new initiatives are required in the way target goals and primary CHD prevention measures are set for patients with type 2 diabetes mellitus.
Yong
Tuck Y
TY
Endocrinology Unit, Queen Elizabeth II Hospital, Adelaide, SA, Australia.
Phillipov
George
G
Phillips
Patrick J
PJ
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000097:blood / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013021:South Australia / Q000453:epidemiology
D000806:Angiotensin-Converting Enzyme Inhibitors; D001241:Aspirin; D002784:Cholesterol; D006442:Glycated Hemoglobin