ORIGINAL ARTICLE
Managing type 2 diabetes mellitus: Role of family physicians in successful treatment goal achievement
More details
Hide details
1
Kharkiv Medical Academy of Postgraduate Education, Ukraine
Online publication date: 2019-07-16
Publication date: 2019-07-16
Electron J Gen Med 2019;16(4):em146
KEYWORDS
TOPICS
ABSTRACT
Introduction:
It is important to emphasize that for most patients with type 2 diabetes mellitus (T2DM), an integrated approach to managing risk factors or the simultaneous modification of all increased risk factors is needed to help reduce the risk of cardiovascular events. Achieving an optimal level of glycated hemoglobin (HbA1c), blood pressure (BP) and LDL cholesterol (LDL) in patients softens macro- and microvascular complications, which is the main goal of treatment in the treatment of type 2 diabetes. This study was aimed at determining the proportion of patients with type 2 diabetes and the aforementioned variable conditions that achieve the triple goals of vascular treatment, based on current practical recommendations.
Methods:
A questionnaire was distributed to adult patients with T2DM and dyslipidemia at primary care clinics in Ukraine. The demographic and clinical data for these patients with both T2DM and dyslipidemia were compared with laboratory data and treatment data obtained from their medical records. The pooled data was then analyzed to determine the proportion of patients who achieved the triple treatment goals, and logistic regression analysis was used to identify the factors associated with this outcome.
Results:
715 eligible patients were recruited [58.9% women] with an average age of 59.8 years. Of these patients, 71.2% achieved LDL-C ≤ 2.6 mmol / L, 70.1% had BP <140/90 mm Hg, and 41.2% reached HbA1c <6.5%. Overall, 23.1% achieved the triple goal of treating glycemia, blood pressure and LDL control. The main determinants were the number of diabetic drugs and the intensity of statin therapy.
Conclusion:
Eight out of ten patients with diabetes mellitus could not achieve the simultaneous goals of treating glycemia, blood pressure and LDL, putting them at risk for vascular complications. Primary health care professionals can reduce these risks by optimizing therapeutic treatment to maximize glycemia, dyslipidemia, and blood pressure control.
REFERENCES (17)
2.
Gaede P, Lund-Andersen H, Parving HH, et al. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med. 2008;358(6):580- 91.
https://doi.org/10.1056/NEJMoa... PMid:18256393.
3.
Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35(6):1364-79.
https://doi.org/10.2337/dc12-0... PMid:22517736 PMCid:PMC3357214.
4.
Diabetes Canada Clinical Practice Guidelines Expert C, Punthakee Z, Goldenberg R, et al. Definition, Classification and Diagnosis of Diabetes, Prediabetes and Metabolic Syndrome. Can J Diabetes. 2018;42 Suppl 1:S10-S5.
https://doi.org/10.1016/j.jcjd... PMid:29650080.
5.
Brownrigg JR, Hughes CO, Burleigh D, et al. Microvascular disease and risk of cardiovascular events among individuals with type 2 diabetes: a population- level cohort study. Lancet Diabetes Endocrinol. 2016;4(7):588-97.
https://doi.org/10.1016/S2213-....
6.
Authors/Task Force M, Ryden L, Grant PJ, et al. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J. 2013;34(39):3035-87.
https://doi.org/10.1093/eurhea... PMid:23996285.
7.
Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint
Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37(29):2315-81.
.
8.
Bethel MA, Patel RA, Merrill P, et al. Cardiovascular outcomes with glucagon- like peptide-1 receptor agonists in patients with type 2 diabetes: a meta-
analysis. Lancet Diabetes Endocrinol. 2018;6(2):105-13.
https://doi.org/10.1016/S2213-....
9.
Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med. 2017;377(7):644-57.
https://doi.org/10.1056/NEJMoa... PMid:28605608.
10.
Vijayakumar S, Vaduganathan M, Butler J. Glucose-Lowering Therapies and
Heart Failure in Type 2 Diabetes Mellitus: Mechanistic Links, Clinical Data, and
Future Directions. Circulation. 2018;137(10):1060-73.
https://doi.org/10.1161/CIRCUL... PMid:29506996 PMCid:PMC5842812.
11.
Rosenstock J, Perkovic V, Johansen OE, et al. Effect of Linagliptin vs Placebo on Major Cardiovascular Events in Adults With Type 2 Diabetes and High Cardiovascular and Renal Risk: The CARMELINA Randomized Clinical Trial. JAMA. 2018.
https://doi.org/10.1001/jama.2... PMid:30418475.
12.
Chamnan P, Simmons RK, Sharp SJ, et al. Cardiovascular risk assessment scores for people with diabetes: a systematic review. Diabetologia. 2009;52(10):2001-14.
https://doi.org/10.1007/s00125... PMid:19629430 PMCid:PMC2744770.
13.
Action to Control Cardiovascular Risk in Diabetes Study G, Gerstein HC, Miller ME, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545-59.
https://doi.org/10.1056/NEJMoa... PMid:18539917 PMCid:PMC4551392.
14.
Korzh O, Krasnokutskiy S. Significance of education and self-management support for patients with chronic heart failure in family physician practice. Fam Med Prim Care Rev 2016; 18(4): 432–436.
https://doi.org/10.5114/fmpcr.....
16.
Ahlqvist E, Storm P, Karajamaki A, et al. Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables. Lancet Diabetes Endocrinol. 2018;6(5):361-9.
https://doi.org/10.1016/S2213-....
17.
Lean ME, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet. 2018;391(10120):541-51.
https://doi.org/10.1016/S0140-....