Back to Search
Start Over
Improved long-term cardiovascular outcomes after intensive versus standard screening of diabetic complications: an observational study.
- Source :
-
Cardiovascular diabetology [Cardiovasc Diabetol] 2019 Sep 16; Vol. 18 (1), pp. 117. Date of Electronic Publication: 2019 Sep 16. - Publication Year :
- 2019
-
Abstract
- Background: Complication screening is recommended for patients with type 2 diabetes (T2D), but the optimal screening intensity and schedules are unknown. In this study, we evaluated whether intensive versus standard complication screening affects long-term cardiovascular outcomes.<br />Methods: In this observational study, we included 368 T2D patients referred for intensive screening provided as a 1-day session of clinical-instrumental evaluation of diabetic complications, followed by dedicated counseling. From a total of 4906 patients, we selected control T2D patients who underwent standard complication screening at different visits, by 2:1 propensity score matching. The primary endpoint was the 4p-MACE, defined as cardiovascular mortality, or non-fatal myocardial infarction, stroke, or heart failure. The Cox proportional regression analyses was used to compare outcome occurrence in the two groups, adjusted for residual confounders.<br />Results: 357 patients from the intensive screening group (out of 368) were matched with 683 patients in the standard screening group. Clinical characteristics were well balanced between the two groups, except for a slightly higher prevalence of microangiopathy in the intensive group (56% vs 50%; standardized mean difference 0.11, p = 0.1). Median follow-up was 5.6 years. The adjusted incidence of 4p-MACE was significantly lower in the intensive versus standard screening group (HR 0.70; 95% CI 0.52-0.95; p = 0.02). All components of the primary endpoint had nominally lower rates in the intensive versus standard screening group, which was particularly significant for heart failure (HR 0.43; 95% CI 0.22-0.83; p = 0.01).<br />Conclusion: Among T2D patients attending a specialist outpatient clinic, intensive complication screening is followed by better long-term cardiovascular outcomes. No significant effect was noted for cardiovascular and all-cause mortality and the benefit was mainly driven by a reduced rate of hospitalization for heart failure.
- Subjects :
- Aged
Ambulatory Care
Cardiovascular Diseases diagnosis
Cardiovascular Diseases mortality
Cardiovascular Diseases prevention & control
Diabetes Complications mortality
Diabetes Complications therapy
Diabetes Mellitus, Type 2 mortality
Diabetes Mellitus, Type 2 therapy
Disease Progression
Female
Heart Failure diagnosis
Heart Failure epidemiology
Humans
Incidence
Italy epidemiology
Male
Middle Aged
Myocardial Infarction diagnosis
Myocardial Infarction epidemiology
Prognosis
Retrospective Studies
Risk Assessment
Risk Factors
Stroke diagnosis
Stroke epidemiology
Time Factors
Cardiovascular Diseases epidemiology
Diabetes Complications diagnosis
Diabetes Mellitus, Type 2 diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1475-2840
- Volume :
- 18
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Cardiovascular diabetology
- Publication Type :
- Academic Journal
- Accession number :
- 31526380
- Full Text :
- https://doi.org/10.1186/s12933-019-0922-1