PDF herunterladen
Exp Clin Endocrinol Diabetes 2022; 130(07): 447-453
DOI: 10.1055/a-1508-3912
Article

Prevalence of Atherosclerotic Cardiovascular Disease, Heart Failure, and Chronic Kidney Disease in Patients with Type 2 Diabetes Mellitus: A Primary Care Research Network-based Study

Geert Goderis
1   Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
,
Bert Vaes
1   Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
,
Pavlos Mamouris
1   Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
,
Eline van Craeyveld
2   Medical Department, Novo Nordisk Pharma Belux, Brussels, Belgium
,
Chantal Mathieu
3   Clinical and Experimental Endocrinology, UZ Gasthuisberg, KU Leuven, Leuven, Belgium
› Institutsangaben Funding Intego is funded regularly by the Flemish Government (Ministry of Health and Welfare). We hereby state the independence of the researchers from the funders. This study was supported by an unrestricted educational grant from Novo Nordisk.
› Weitere Informationen
Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Aims This study aims to assess the prevalence of atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), chronic kidney disease (CKD), and their combined presence in type 2 diabetes (T2D) patients in primary care for whom the 2019 ADA/EASD consensus update “Management of Hyperglycemia in Type 2 Diabetes” recommends GLP-1 receptor agonists (GLP-1RA) or sodium-glucose cotransporter-2 inhibitors (SGLT-I) as first-line medications after metformin.

Methods Data were obtained in 2015 from Intego, a morbidity registration network of 111 general practitioners (GPs) working in 48 practices and including 123 261 registered patients.

Results Of 123 261 patients, 9616 had T2D. Of these patients, 4200 (43.7%) presented with ASCVD and/or CKD and/or HF. Specifically, 3348 (34.8%) patients had ASCVD, 388 (4.0%) had heart failure, and 1402 (14.6%) had CKD. Compared to patients without any of these comorbidities, patients with at least 1 of these conditions were older (69.7 ±12.6 vs. 63.1±12.5 years), had higher LDL-C values (104.2±35.8 mg/dl vs. 97.2±37.7) and less frequently achieved the systolic blood pressure target of 140 mm Hg (53 vs. 61%) (all p<0.001). Comorbid patients also had significantly more other comorbidities, such as dementia or cancer; received more recommended medications, such as statins; and received less metformin. Most patients with HF (325; 3.4%) had ASCVD (114; 1.2%), CKD (76; 0.8%), or both (135; 1.4%). In total, 478 patients with CKD (5.0%) also had ASCVD.

Conclusions At the primary care level, 44% of T2D patients suffer from ASCVD, CKD, and/or HF, and thus qualify for GLP-1RA or SGLT2-I therapy.

Key words

ASCVD - heart failure - CKD - type 2 diabetes mellitus

Supplementary Material



Publikationsverlauf

Eingereicht: 11. Februar 2021
Eingereicht: 16. April 2021

Angenommen: 26. April 2021

Artikel online veröffentlicht:
21. Juni 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Yang W, Dall TM, Beronjia K. et al. Economic costs of diabetes in the U.S. in 2017. Diabetes Care 2018; 41: 917-28
    CrossrefPubMedSuche in Google Scholar
  • 2 Di Angelantonio E, Kaptoge S, Wormser D. et al. Association of cardiometabolic multimorbidity with mortality. J Am Med Assoc 2015; 314
    CrossrefPubMedSuche in Google Scholar
  • 3 Cubbon RM, Adams B, Rajwani A. et al. Diabetes mellitus is associated with adverse prognosis in chronic heart failure of ischaemic and non-ischaemic aetiology. Diab Vasc Dis Res 2013; 10: 330-336
    CrossrefPubMedSuche in Google Scholar
  • 4 Kannel WB, Hjortland M, Castelli WP. Role of diabetes in congestive heart failure: the Framingham study. Am J Cardiol 1974; 34: 29-34
    CrossrefPubMedSuche in Google Scholar
  • 5 Davies MJ, D’Alessio DA, Fradkin J. , et al. Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2018; 2012: dci180033
    CrossrefPubMedSuche in Google Scholar
  • 6 Reidy K, Kang HM, Hostetter T, Susztak K. Molecular mechanisms of diabetic kidney disease. J Clin Investig 2014; 124: 2333-2340
    CrossrefPubMedSuche in Google Scholar
  • 7 Gheith O, Othman N, Nampoory N. , et al. Diabetic kidney disease: difference in the prevalence and risk factors worldwide. J Egypt Soc Nephrol Transplanta 2016; 16: 65
    CrossrefPubMedSuche in Google Scholar
  • 8 Mann JFE, Ørsted DD, Brown-Frandsen K. et al. Liraglutide and renal outcomes in Type 2 diabetes. N Eng. J Med 2017; 377: 839-848
    CrossrefPubMedSuche in Google Scholar
  • 9 Marso SP, Bain SC, Consoli A. et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Eng. J Med 2016; 375: 1834-1844
    CrossrefPubMedSuche in Google Scholar
  • 10 Gerstein HC, Colhoun HM, Dagenais GR. et al. Dulaglutide and renal outcomes in type 2 diabetes: An exploratory analysis of the REWIND randomised, placebo-controlled trial. The Lancet 2019; 394: 131-138
    CrossrefPubMedSuche in Google Scholar
  • 11 Zinman B, Wanner C, Lachin JM. et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Eng J Med 2015; 373: 2117-2228
    CrossrefPubMedSuche in Google Scholar
  • 12 Neal B, Perkovic V, Mahaffey KW. et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Eng. J Med 2017; 377: 644-657
    CrossrefPubMedSuche in Google Scholar
  • 13 Perkovic V, Jardine MJ, Neal B. et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Eng J Med 2019; 380: 2295-2306
    CrossrefPubMedSuche in Google Scholar
  • 14 Bae JH, Park EG, Kim S. et al. Effects of sodium-glucose cotransporter 2 inhibitors on renal outcomes in patients with type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. Sci Rep 2019; 9: 1-9
    CrossrefPubMedSuche in Google Scholar
  • 15 Buse JB, Wexler DJ, Tsapas A. et al. 2019 Update to: Management of hyperglycemia in Type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2020; 43: 487-493
    Suche in Google Scholar
  • 16 Care D, Suppl SS. 9. Pharmacologic approaches to glycemic treatment: standards of medical care in diabetes—2020. Diabetes Care 2020; 43: S98-S110
    CrossrefPubMedSuche in Google Scholar
  • 17 Care D, Suppl SS. 10. Cardiovascular disease and risk management: standards of medical care in diabetes—2020. Diabetes Care 2020; 43: S111-S34
    CrossrefPubMedSuche in Google Scholar
  • 18 Truyers C, Goderis G, Dewitte H. et al. The Intego database: background, methods and basic results of a Flemish general practice-based continuous morbidity registration project. BMC Med Inform Decis Mak 2014; 14: 48
    CrossrefPubMedSuche in Google Scholar
  • 19 World Organization of National Colleges Academies and Academic Associations of General Practitioners/Family Physicians. ICPC-2 international classification of primary care. Oxford Medical Publications 1998
    PubMed
  • 20 Vaes B, Beke E, Truyers C. et al. The correlation between blood pressure and kidney function decline in older people: A registry-based cohort study. BMJ Open 2015; 5: e007571
    CrossrefPubMedSuche in Google Scholar
  • 21 Stone NJ, Robinson JG, Lichtenstein AH. et al. Treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease risk in adults: Synopsis of the 2013 American College of Cardiology/American Heart Association cholesterol guideline. Ann Int Med 2014; 160: 339-343
    CrossrefPubMedSuche in Google Scholar
  • 22 KDIGO. 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney International Supplements 2013; 3: 136-50
    CrossrefPubMedSuche in Google Scholar
  • 23 McGurnaghan S, Blackbourn LAK, Mocevic E. et al. Cardiovascular disease prevalence and risk factor prevalence in Type 2 diabetes: a contemporary analysis. Diabet Med 2019; 36: 718-725
    CrossrefPubMedSuche in Google Scholar
  • 24 Lautsch D, Wang T, Yang L, Rajpathak SN. Prevalence of established cardiovascular disease in patients with type 2 diabetes mellitus in the UK. Diabetes Ther 2019; 10: 2131-2137
    CrossrefPubMedSuche in Google Scholar
  • 25 Rungby J, Schou M, Warrer P. et al. Prevalence of cardiovascular disease and evaluation of standard of care in type 2 diabetes: a nationwide study in primary care. Cardiovasc Endocrinol 2017; 6: 145-151
    CrossrefPubMedSuche in Google Scholar
  • 26 Einarson TR, Acs A, Ludwig C, Panton UH. Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007–2017. Cardiovasc Diabetol 2018; 17: 1-19
    CrossrefPubMedSuche in Google Scholar
  • 27 Bailey RA, Wang Y, Zhu V, Rupnow MF. Chronic kidney disease in US adults with type 2 diabetes: An updated national estimate of prevalence based on Kidney Disease: Improving Global Outcomes (KDIGO) staging. BMC Res Notes 2014; 7: 1-7
    CrossrefPubMedSuche in Google Scholar
  • 28 Detournay B, Simon D, Guillausseau PJ. et al. Chronic kidney disease in type 2 diabetes patients in France: prevalence, influence of glycaemic control and implications for the pharmacological management of diabetes. Diabetes Metab 2012; 38: 102-112
    CrossrefPubMedSuche in Google Scholar
  • 29 Deaton C, Benson J. Time for correct diagnosis and categorisation of heart failure in primary care. Br J Gen Pract 2016; 66: 554-555
    CrossrefPubMedSuche in Google Scholar
  • 30 Van Riet EES, Hoes AW, Limburg A. et al. Prevalence of unrecognized heart failure in older persons with shortness of breath on exertion. Eur J Heart Fail 2014; 16: 772-777
    CrossrefPubMedSuche in Google Scholar