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Quality of care and clinical inertia in the management of cardiovascular risk factors in patients with type 1 and type 2 diabetes: data from AMD annals

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Abstract

Background

Cardiovascular disease is the leading cause of morbidity and mortality among patients with diabetes, and for this reason, all guidelines for CV risk management provide the same targets in controlling traditional CV risk factors in patients with type 1 or type 2 diabetes at equal CV risk class. Aim of our study was to evaluate and compare CV risk management in patients with type 1 and type 2 diabetes included in AMD Annals Database paying particular attention to indicators of clinical inertia.

Methods

This was a multicenter, observational, retrospective study of AMD Annals Database during year 2022. Patients with diabetes were stratified on the basis of their cardiovascular risk, according to ESC-EASD guidelines. The proportion of patients not treated with lipid-lowering despite LDL cholesterol > to 100 mg/dl or the proportion of patients not treated with antihypertensive drug despite BP > 140/90 mmhg and proportion of patients with proteinuria not treated with angiotensin converting enzyme inhibitors or angiotensinogen receptor blockers (ACE/ARBs) were considered indicators of clinical inertia. The proportion of patients reaching at the same time HbA1c < 7% LDL < 70 mg/dl and BP < 130/80 mmhg were considered to have good multifactorial control. Overall quality of health care was evaluated by the Q-score.

Results

Using the inclusion criteria and stratifying patients by ESC/EASD Cardiovascular Risk categories, we included in the analysis 118.442 patients at High Cardiovascular risk and 416.246 patients at Very High Cardiovascular risk. The proportion of patients with good multifactorial risk factor control was extremely low in both T1D and T2D patients in each risk class. At equal risk class, the patients with T1D had lower proportion of subjects reaching HbA1c, LDL, or Blood Pressure targets. Indicators of clinical inertia were significantly higher compared with patients with T2D at equal risk class. Data regarding patients with albuminuria not treated with RAAS inhibitors were available only for those at Very High risk and showed that the proportion of patients not treated was again significantly higher in patients with T1DM.

Conclusions

In conclusion, this study provides evidence of wide undertreatment of traditional cardiovascular risk factors among patients with diabetes included in AMD Annals Database. Undertreatment seems to be more pronounced in individuals with T1D compared to those with T2D and is frequently due to clinical inertia.

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Data availability

Data described in the manuscript, code book, and analytic code will be made available upon request pending application and approval of all authors.

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Authors and Affiliations

  1. Diabetes and Metabolism Unit, Clinica Medica, University of Udine, Udine, Italy

    A. Da Porto

  2. Department of Medical Surgical and Health Sciences, University of Trieste, Diabetes Center, ASUGI, Trieste, Italy

    R. Candido

  3. “G. Segalini” H. Bassini Cinisello Balsamo ASST Nord, Milan, Italy

    A. Rocca

  4. AMD Foundation, Reggio Emilia, Italy

    V. Manicardi

  5. Center for Outcomes Research and Clinical Epidemiology–CORESEARCH, Pescara, Italy

    A. Nicolucci

  6. Endocrinology and Diabetes Unit, ASFO, Pordenone, Italy

    C. Miranda

  7. UOC Medicina Generale ad Indirizzo Metabolico e Diabetologico, ASST Spedali Civili of Brescia, Brescia, Italy

    E. Cimino

  8. Ravenna Diabetes Center–Romagna Local Health Authority, Ravenna, Italy

    P. Di Bartolo

  9. USL Tuscany Northwest Location Livorno, Diabetes and Metabolic Disease, Livorno, Italy

    G. Di Cianni

  10. Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy

    G. Russo

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  1. A. Da Porto
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Correspondence to A. Da Porto.

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All participating diabetes centers obtained the authorization of the local Ethics Committee.

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Informed consent was obtained from all subjects and centers involved in this study.

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Da Porto, A., Candido, R., Rocca, A. et al. Quality of care and clinical inertia in the management of cardiovascular risk factors in patients with type 1 and type 2 diabetes: data from AMD annals. J Endocrinol Invest (2024). https://doi.org/10.1007/s40618-024-02327-0

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