TY  - JOUR
AU  - Paul, SK
AU  - Klein, K
AU  - Thorsted, BL
AU  - Wolden, ML
AU  - Khunti, K
Y2  - 2020/12/22
Y1  - 2015/08/07
SN  - 1475-2840
UR  - http://hdl.handle.net/11343/257695
AB  - BACKGROUND: 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.
LA  - English
PB  - BMC
T1  - Delay in treatment intensification increases the risks of cardiovascular events in patients with type 2 diabetes
DO  - 10.1186/s12933-015-0260-x
IS  - Cardiovascular Diabetology
VL  - 14
IS  - 1
L1  - /bitstream/handle/11343/257695/PMC4528846.pdf?sequence=1&isAllowed=y
ER  -