Key result
Patients in the best control GP practices cluster were more likely to achieve HbA1c <7% (OR 2.46; 95% CI 2.29-3.64), which was associated with decreased hospital admissions for cardiovascular events.
Why the study?
Type 2 diabetes increases cardiovascular morbidity, mortality, and hospitalizations, with variability in clinical practice, prompting an evaluation of variability in risk factor control and its impact on admissions for cardiovascular events.
Does optimal control of HbA1c, blood pressure, and LDL cholesterol in primary care reduce hospital admissions for cardiovascular events in patients with Type 2 diabetes?
Cohort (n=480,637)
Yes
Does optimal control of HbA1c, blood pressure, and LDL cholesterol in primary care reduce hospital admissions for cardiovascular events in patients with Type 2 diabetes?
Odds Ratio: 2.46 (95% CI 2.29–3.64)
Optimal control of HbA1c, blood pressure, and LDL cholesterol in primary care is associated with a reduced risk of hospital admissions for cardiovascular events in patients with type 2 diabetes.
HbA1c control variability was associated with higher CVE admissions; leaves open whether standardizing targets reduces events in T2D.
Type 2 diabetes (T2D) is associated with increased cardiovascular morbidity, mortality, and hospital admissions. There is variability in clinical practice. The objectives are to analyze the variability in the control of Blood Pressure (BP), HbA1c, and LDL-C in T2D patients and its influence on admissions due to cardiovascular events (CVE) Methods: We analyzed the electronic records in Primary Care Health centers in Navarra (Spain) and hospital admission for CVE. We follow 480637 people from 2012 to 2016. We calculated indicators of control of patients with T2D for each year, percentage with: HbA1c < 7%; HbA1c >= 9%; BP <140/90 mmHg; LDL-C <100 mg/dl. We used logistic and Cox regression. Results: Patients in the best control GP practices cluster are 2.5 times more likely to have HbA1c <7% [OR: 2.46 (95% CI: 2.29-3.64)]. Poor HbA1c control ≥ 9% is more likely in the worst control cluster [OR: 1.73 (95% CI:1.63-1.83)]. The probability of admission for CVE increases with age, being male, low income, obesity, history of CVE, having HbA1c ≥ 9%, and belonging to a GP practice in the cluster of HbA1C ≥ 9% worst control. In contrast, it decreases in patients with HbA1c <7%, BP<140/90 mmHg and LDL <100 mg/dl.
No takes yet. Share an insight, caveat, or question.
Guillén-Aguinaga et al. (2021) conducted a cohort in Type 2 diabetes (n=480,637). Best control GP practices cluster vs. Worst control GP practices cluster was evaluated on HbA1c < 7% (OR 2.46, 95% CI 2.29-3.64). Patients in the best control GP practices cluster were more likely to achieve HbA1c <7% (OR 2.46; 95% CI 2.29-3.64), which was associated with decreased hospital admissions for cardiovascular events.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: