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dc.contributor.authorPaul, SK
dc.contributor.authorKlein, K
dc.contributor.authorThorsted, BL
dc.contributor.authorWolden, ML
dc.contributor.authorKhunti, K
dc.date.accessioned2020-12-22T02:42:45Z
dc.date.available2020-12-22T02:42:45Z
dc.date.issued2015-08-07
dc.identifierpii: 10.1186/s12933-015-0260-x
dc.identifier.citationPaul, S. K., Klein, K., Thorsted, B. L., Wolden, M. L. & Khunti, K. (2015). Delay in treatment intensification increases the risks of cardiovascular events in patients with type 2 diabetes. CARDIOVASCULAR DIABETOLOGY, 14 (1), https://doi.org/10.1186/s12933-015-0260-x.
dc.identifier.issn1475-2840
dc.identifier.urihttp://hdl.handle.net/11343/257695
dc.description.abstractBACKGROUND: The aim of the study was to evaluate the effect of delay in treatment intensification (IT; clinical inertia) in conjunction with glycaemic burden on the risk of macrovascular events (CVE) in type 2 diabetes (T2DM) patients. METHODS: A retrospective cohort study was carried out using United Kingdom Clinical Practice Research Datalink, including T2DM patients diagnosed from 1990 with follow-up data available until 2012. RESULTS: In the cohort of 105,477 patients mean HbA1c was 8.1% (65 mmol/mol) at diagnosis, 11% had a history of cardiovascular disease, and 7.1% experienced at least one CVE during 5.3 years of median follow-up. In patients with HbA1c consistently above 7/7.5% (53/58 mmol/mol, n = 23,101/11,281) during 2 years post diagnosis, 26/22% never received any IT. Compared to patients with HbA1c <7% (<53 mmol/mol), in patients with HbA1c ≥7% (≥53 mmol/mol), a 1 year delay in receiving IT was associated with significantly increased risk of MI, stroke, HF and composite CVE by 67% (HR CI: 1.39, 2.01), 51% (HR CI: 1.25, 1.83), 64% (HR CI: 1.40, 1.91) and 62% (HR CI: 1.46, 1.80) respectively. One year delay in IT in interaction with HbA1c above 7.5% (58 mmol/mol) was also associated with similar increased risk of CVE. CONCLUSIONS: Among patients with newly diagnosed T2DM, 22% remained under poor glycaemic control over 2 years, and 26% never received IT. Delay in IT by 1 year in conjunction with poor glycaemic control significantly increased the risk of MI, HF, stroke and composite CVE.
dc.languageEnglish
dc.publisherBMC
dc.titleDelay in treatment intensification increases the risks of cardiovascular events in patients with type 2 diabetes
dc.typeJournal Article
dc.identifier.doi10.1186/s12933-015-0260-x
melbourne.affiliation.departmentGeneral Practice
melbourne.affiliation.departmentMedicine and Radiology
melbourne.source.titleCardiovascular Diabetology
melbourne.source.volume14
melbourne.source.issue1
dc.rights.licenseCC BY
melbourne.elementsid996583
melbourne.contributor.authorKhunti, Kamlesh
melbourne.contributor.authorPaul, Sanjoy
dc.identifier.eissn1475-2840
melbourne.accessrightsOpen Access


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