Contrasting cardiovascular risk profiles and prescribed cardio-protective therapies in newly-diagnosed type 2 diabetes identified through screening and standard practice

• Published in: Diabetes research and clinical practice Vol. 91; no. 3; pp. 280 - 285
• Main Authors: Webb, D.R, Gray, L.J, Khunti, K, Campbell, S, Dallosso, H, Davies, M.J
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01-03-2011
• Subjects: Adult; Aged; Antihypertensive Agents - therapeutic use; Cardiotonic Agents - therapeutic use; Cardiovascular disease; Cardiovascular Diseases; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Diagnosis; Dyslipidemias - complications; Endocrinology & Metabolism; Humans; Hyperglycemia - complications; Hypertension - complications; Hypolipidemic Agents - therapeutic use; Mass Screening; Middle Aged; Risk Factors; Screening; Type 2 Diabetes; Screening; Cardiovascular disease; Diagnosis; Type 2 Diabetes
• ISSN: 0168-8227; 1872-8227
• DOI: 10.1016/j.diabres.2010.11.021

Abstract Aims Screening for Type 2 diabetes mellitus (T2DM) may improve long-term outcomes by managing cardiovascular risk at an earlier stage of the disease. The cardiovascular risk profile of screen-detected (SD) T2DM is ill defined and has not been compared to conventional newly diagnosed (CD) cases. Methods Baseline data from SD ( n = 337) and CD ( n = 824) cohorts were compared. SD adopted mixed approaches to screening, population based ( n = 214) and cardiovascular-risk factor targeted ( n = 123). CD reflected UK primary care practice with cases referred within four weeks of diagnosis. Results People with SD T2DM were leaner, had a lower HbA1c(%) and lower triglyceride but were more hypertensive compared to people with CD T2DM. Fewer SD were on blood pressure lowering (46% vs. 60%, p < 0.0001), statin (30% vs. 41%, p < 0.0001) or anti-platelet (15% vs. 27%, p < 0.0001) therapies. Modelled 10 year cardiovascular disease (CVD) risk was actually greater in the SD group compared to CD (CVD: 20.8 vs. 17.2, p = 0.0001). Conclusion Individuals with SD T2DM are at high risk of CVD as a result of untreated hyperglycaemia, hypertension and dyslipidaemia. Those prescribed antihypertensive or lipid-lowering therapies frequently still had inadequate control. Identifying vascular risk by screening for latent glucose disease provides therapeutic opportunities for earlier intervention.