Key result
Early specialist visits link to ~30% lower major cardiovascular events in diabetes with ASCVD but higher risk without.
Why the study?
Given patient heterogeneity and specific needs in established ASCVD, this study sought to describe specialist visit trajectories among diabetes cases with and without ASCVD and explore associations with MACE.
Do specialist visit trajectories reduce major adverse cardiovascular events in patients with new-onset diabetes?
Cohort (n=29,950)
Do specialist visit trajectories reduce major adverse cardiovascular events in patients with new-onset diabetes?
Early specialist visits after new-onset diabetes are associated with reduced MACE risk in patients with established ASCVD, but increased risk in those without ASCVD, suggesting the need for risk-stratified referral strategies.
Answers are grounded in this paper and cite their sources.
Supports risk-stratified specialist referral in new-onset diabetes; leaves open causality and optimal strategies pending trials.
Background: Specialist physicians may play a role in preventing major adverse cardiovascular events (MACE) (myocardial infarction/stroke/cardiovascular deaths) in patients with diabetes.Given the heterogeneity in patients and the specific needs in established atherosclerotic cardiovascular disease (ASCVD), this study sought to describe the trajectories of visits to specialists among diabetes cases with/without ASCVD and explore their associations with MACE.Methods: Using Quebec's administrative databases, we identified new-onset diabetes cases aged 20 years with no history of MACE in 2013.Individual trajectories based on outpatient visits to a specialist (cardiologist/internist/endocrinologist) were compiled for consecutive 3-month periods, up to 2 years after diagnosis, and grouped using latent class growth analysis.We assessed the risk of MACE using weighted Cox regression models according to ASCVD status, from year 2 postdiagnosis up to 31-12-2019.Results: Four trajectory groups were identified: 1) Regular/Frequent visits (n=1,810); 2) Early visits only (n=1,420); 3) Regular/Sparse visits (n=8,670); 4) Primary care only (n=18,050).Patients with ASCVD consulted more specialists compared to those without ASCVD.Among patients with ASCVD (n=4,800), the Early visits only group had a lower risk of MACE (adjusted hazard ratio [aHR]:0.70 [95% confidence intervals:0.49-0.97]),compared with the Primary care only group, while for patients without ASCVD (n=25,150), the risk of MACE was higher in the Early visits only (aHR:1.76[1.44-2.12])and Regular/Sparse visits groups (aHR:1.26[1.13-1.41]).Conclusions: This study highlights great diversity in diabetes care trajectories according to ASCVD status.We found conflicting results in the risk of MACE, and some results should be interpreted with caution.
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O’Connor et al. (2026) conducted a cohort in new-onset diabetes (n=29,950). Early specialist visits vs. Primary care only was evaluated on major adverse cardiovascular events (MACE) (aHR 0.70, 95% CI 0.49-0.97). Early specialist visits lowered major cardiovascular events risk in diabetes patients with ASCVD but increased risk in those without ASCVD versus primary care.
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