title: Impact of UKPDS risk estimation added to a first subjective risk estimation on management of coronary disease risk in type 2 diabetes - An observational study.
abstract: OBJECTIVE
  To investigate the impact of the UKPDS risk engine on management of CHD risk in T2DM patients.
  
  
  METHODS
  Observational study among 139 GPs. Data from 933 consecutive patients treated with a maximum of two oral glucose lowering drugs, collected at baseline and after twelve months. GPs estimated the CHD risk themselves and afterwards they calculated this with the UKPDS risk engine. Under- and overestimation were defined as a difference >5 percentage points difference between both calculations. The impact of the UKPDS risk engine was assessed by measuring differences in medication adjustments between the over-, under- and accurately estimated group.
  
  
  RESULTS
  In 42.0% the GP accurately estimated the CHD risk, in 32.4% the risk was underestimated and in 25.6% overestimated. Mean difference between the estimated (18.7%) and calculated (19.1%) 10 years CHD risk was -0.36% (95% CI -1.24 to 0.52). Male gender, current smoking and total cholesterol level were associated with underestimation. Patients with an subjectively underestimated CHD risk received significantly more medication adjustments. Their UKPDS 10 year CHD risk did not increase during the follow-up period, contrary to the other two groups of patients.
  
  
  CONCLUSIONS
  The UKPDS risk engine may be of added value for risk management in T2DM.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str. 6,131, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Wind
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str. 6,131, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: Kees J
authors.initials: KJ
authors.lastname: Gorter
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str. 6,131, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
authors.forename: Maureen
authors.initials: M
authors.lastname: van den Donk
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str. 6,131, P.O. Box 85500, 3508 GA Utrecht, The Netherlands. Electronic address: g.e.h.m.rutten@umcutrecht.nl.
authors.forename: Guy E H M
authors.initials: GE
authors.lastname: Rutten
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D003327:Coronary Disease / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D003661:Decision Support Techniques; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D058006:General Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D007004:Hypoglycemic Agents
keywords: Cardiovascular risk management; Diabetes mellitus; Risk assessment; Type 2; UKPDS risk engine