Key result
Treatment intensification in T2D is linked to ~0.82 mmol/L lower short-term LDL-C and improved SBP.
Why the study?
The association between quality indicators for treatment of cardiovascular and renal risk factors and short-term outcomes in patients with diabetes was unclear.
Are quality indicators for treatment of cardiovascular and renal risk factors associated with short-term outcomes in patients with type 2 diabetes?
Cohort (n=15,453)
Are quality indicators for treatment of cardiovascular and renal risk factors associated with short-term outcomes in patients with type 2 diabetes?
Quality indicators of treatment intensification predict better short-term cardiovascular and renal surrogate outcomes in patients with type 2 diabetes.
Answers are grounded in this paper and cite their sources.
Supports treatment intensification quality metrics in type 2 diabetes; leaves open effects on hard outcomes.
OBJECTIVE: To assess whether quality indicators for treatment of cardiovascular and renal risk factors are associated with short-term outcomes in patients with diabetes. DESIGN: A prospective cohort study using linear regression adjusting for confounders. SETTING: The GIANTT database (Groningen Initiative to Analyse Type 2 Diabetes Treatment) containing data from primary care medical records from The Netherlands. PARTICIPANTS: 15 453 patients with type 2 diabetes mellitus diagnosed before 1 January 2008. Mean age 66.5 years, 47.5% men. EXPOSURE: Quality indicators assessing current treatment (CT) status or treatment intensification (TI) for patients with diabetes with elevated cardiovascular or renal risk factors. MAIN OUTCOME MEASURES: Low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), and albumin:creatinine ratio (ACR) before and after assessment of treatment quality. RESULTS: Use of lipid-lowering drugs was associated with better LDL-C levels (-0.41 mmol/litre; 95% CI -0.48 to -0.34). Use of blood pressure-lowering drugs and use of renin-angiotensin system inhibitors in patients with elevated risk factor levels was not associated with better SBP and ACR outcomes, respectively. TI was also associated with better LDL-C (-0.82 mmol/litre; CI -0.93 to -0.71) in patients with elevated LDL-C levels, and with better SBP (-1.26 mm Hg; CI -2.28 to -0.24) in patients with two elevated SBP levels. Intensification of albuminuria-lowering treatment showed a tendency towards better ACR (-2.47 mmol/mg; CI -5.32 to 0.39) in patients with elevated ACR levels. CONCLUSIONS: Quality indicators of TI were predictive of better short-term cardiovascular and renal outcomes, whereas indicators assessing CT status showed association only with better LDL-C outcome.
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Sidorenkov et al. (2013) conducted a cohort in Type 2 diabetes mellitus (n=15,453). Quality indicators assessing current treatment status or treatment intensification was evaluated on Low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), and albumin:creatinine ratio (ACR) (MD -0.82 mmol/litre, 95% CI -0.93 to -0.71). Treatment intensification in patients with type 2 diabetes was associated with better short-term LDL-C (-0.82 mmol/L; 95% CI -0.93 to -0.71) and systolic blood pressure (-1.26 mm Hg).
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