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Quality of Care Among Patients with Diabetes and Cerebrovascular Disease. Insights from The Diabetes Collaborative Registry

      Clinical significance

      • The extent of implementation of guideline recommended therapy in type 2 diabetes patients and isolated cerebrovascular disease is unknown.
      • In a large US outpatient registry of type 2 diabetes patients, those with isolated cerebrovascular disease had lowest rates of secondary cardiovascular prevention goals attainment as compared to patients with cerebrovascular disease plus coronary artery disease or peripheral artery disease, or those with isolated coronary artery disease/peripheral artery disease.

      ABSTRACT

      Background

      Although secondary cardiovascular prevention is a focus among patients with type 2 diabetes (T2D) and coronary artery disease (CAD) or peripheral artery disease (PAD), the application of guideline recommended therapy in T2D patients and isolated cerebrovascular disease (CeVD) remains unknown.

      Methods

      In a US outpatient registry, T2D patients with established cardiovascular disease from 2014-2018 were categorized as: isolated CeVD, CeVD plus CAD or PAD, or isolated CAD/PAD. In each group, we determined the proportion with optimal secondary prevention (HbA1C< 8%, blood pressure [BP] <130/80 mmHg, use of antithrombotics, use of statins, non-smoking/cessation counseling, and use of glucose-lowering medications with cardioprotective effects [sodium-glucose cotransporter [SGLT]-2 inhibitors, glucagon-like peptide [GLP]-1 receptor agonists, thiazolidinediones [TZDs]). Hierarchical Poisson regression was used to estimate relative rate of achieving each target across groups, adjusted for age and chronic kidney disease (where relevant).

      Results

      Our study included 72,7467 T2D outpatients with cardiovascular disease (isolated CeVD [n=99,777], CeVD plus CAD/PAD [n=158,361], isolated CAD/PAD [n=469,329]). Compared with isolated CAD/PAD patients, isolated CeVD patients more often had an HbA1C<8% (adjusted relative risk [aRR]: 1.10, 95% CI 1.08-1.11) but less often had a BP ≤130/80 mmHg (aRR: 0.93, 95% CI 0.92-0.94]) or were prescribed antithrombotics (0.84, 95% CI 0.83-0.85), statins (0.86, 95% CI 0.85-0.87), GLP-1 agonists (0.75, 95% CI 0.73-0.78), SGLT2 inhibitors (0.73, 95% CI 0.71-0.76), and TZDs (aRR 0.76, 95% CI 0.73-0.78).

      Conclusion

      Among T2D patients, those with isolated CeVD had the lowest rates of secondary cardiovascular prevention goals attainment. More focus is needed on secondary prevention in patients with CeVD.

      Key Words

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