[Cardiovascular risk management in type-2 diabetes: Is the patients' cardiovascular risk adequately considered in type-2 specialist diabetes care?] / Kardiovaskuläres Risikomanagement bei Typ-2 Diabetes: Werden Menschen mit Typ-2 Diabetes in der diabetologischen Schwerpunktpraxis kardiovaskulär risikoadjustiert behandelt?

INTRODUCTION AND OBJECTIVES: More than 50% of the type-2 Diabetes (T2DM) mortality is due to cardiovascular disease. Current treatment guidelines recommend an increasingly differentiated and comprehensive management of cardiovascular risk factors. This study aims to measure the extent to which T2DM care is currently adjusted for cardiovascular risks in clinical practice. METHODS: This observational study included 123 T2DM patients of nine outpatient diabetology specialist clinics in Southern Germany. Guideline adherence was measured based on selected aspects of the joint guideline of the European Society of Cardiology (ESC) and the European Society for the Study of Diabetes (EASD). The proportion of patients with treatment target adherence, monitoring adherence, and therapy adherence for the areas of blood pressure and lipid metabolism management was determined, and the correlation between adherence and treatment outcome was assessed by comparing treatment target achievement rates between the group that received guideline-adherent care and the group with no guideline-adherent care. RESULTS: The combined adherence rates were 39% for blood pressure management and 10% for lipid management. 70% of the participants with adherent blood pressure management and 56% with non-adherent blood pressure management achieved the blood pressure target (p=0.165). 50% of the patients with guideline-adherent lipid management and 17% with not guideline-adherent lipid management achieved the LDL cholesterol target (p=0.032). DISCUSSION: Less than half of the study population received care that was adequately adjusted for cardiovascular risks. Participants that received risk-adjusted care achieved their treatment target for blood pressure and LDL cholesterol more often. In order to validate methods and results, the study should be repeated with routine care data from a larger study population. CONCLUSION: Guideline-adherent care pays off: cardiovascular risk-adjusted care, especially following the more differentiated ESC/EASC guideline 2019, increases the chance for T2DM patients to avoid or delay cardiovascular complications.