| アブストラクト | 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. |
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| ジャーナル名 | Cardiovascular diabetology |
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| 投稿日 | 2015/8/8 |
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| 投稿者 | Paul, Sanjoy K; Klein, Kerenaftali; Thorsted, Brian L; Wolden, Michael L; Khunti, Kamlesh |
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| 組織名 | Clinical Trials and Biostatistics Unit, QIMR Berghofer Medical Research;Institute, 300 Herston Road, Herston, Brisbane, QLD, 4006, Australia.;Sanjoy.Paul@qimrberghofer.edu.au.;kerenaftali.klein@qimrberghofer.edu.au.;Novo Nordisk A/S, Vandtarnsvej, Denmark. bltt@novonordisk.com.;Novo Nordisk A/S, Vandtarnsvej, Denmark. mlwo@novonordisk.com.;Leicester Diabetes Centre, University of Leicester, Leicester, UK. kk22@le.ac.uk. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/26249018/ |
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