Department of Endocrinology, Endocrinology and Metabolism Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk F-20, Cleveland, OH, USA.
Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
Cardiovasc Diabetol. 2018 Apr 10;17(1):54. doi: 10.1186/s12933-018-0699-7.
To evaluate real-world patient characteristics, medication use, and health care utilization patterns in patients with type 2 diabetes with established cardiovascular disease (CVD).
Cross-sectional analysis of patients with type 2 diabetes seen at Cleveland Clinic from 2005 to 2016, divided into two cohorts: with-CVD and without-CVD. Patient demographics and antidiabetic medications were recorded in December 2016; department encounters included all visits from 1/1/2016 to 12/31/2016. Comorbidity burden was assessed by the diabetes complications severity index (DCSI) score.
Of 95,569 patients with type 2 diabetes, 40,910 (42.8%) were identified as having established CVD. Patients with CVD vs. those without were older (median age 69.1 vs. 58.2 years), predominantly male (53.8% vs. 42.6%), and more likely to have Medicare insurance (69.4% vs. 35.3%). The with-CVD cohort had a higher proportion of patients with a DCSI score ≥ 3 than the without-CVD cohort (65.0% vs. 10.3%). Utilization rates of glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors were low in both with-CVD (4.1 and 2.5%) and without-CVD cohorts (5.4 and 4.1%), respectively. The majority of patient visits (75%) were seen by a primary care provider. During the 1-year observation period, 81.9 and 62.0% of patients with type 2 diabetes and CVD were not seen by endocrinology or cardiology, respectively.
These data indicated underutilization of specialists and antidiabetic medications reported to confer CV benefit in patients with type 2 diabetes and CVD. The impact of recently updated guidelines and cardiovascular outcome trial results on management patterns in such patients remains to be seen.
评估患有已确诊心血管疾病（CVD）的 2 型糖尿病患者的真实患者特征、药物使用情况和医疗保健利用模式。
对 2005 年至 2016 年在克利夫兰诊所就诊的 2 型糖尿病患者进行横断面分析，分为有 CVD 和无 CVD 两组。2016 年 12 月记录患者的人口统计学和抗糖尿病药物情况；科室就诊包括 2016 年 1 月 1 日至 12 月 31 日的所有就诊。采用糖尿病并发症严重程度指数（DCSI）评分评估合并症负担。
在 95569 例 2 型糖尿病患者中，有 40910 例（42.8%）被确定为患有已确诊 CVD。与无 CVD 患者相比，CVD 患者年龄更大（中位数年龄 69.1 岁 vs. 58.2 岁），男性比例更高（53.8% vs. 42.6%），且更有可能拥有医疗保险（69.4% vs. 35.3%）。与无 CVD 患者相比，CVD 患者 DCSI 评分≥3 的比例更高（65.0% vs. 10.3%）。在 CVD 患者和无 CVD 患者中，胰高血糖素样肽-1 受体激动剂和钠-葡萄糖共转运蛋白-2 抑制剂的使用率均较低（分别为 4.1%和 2.5%，5.4%和 4.1%）。大多数患者就诊（75%）由初级保健提供者进行。在 1 年观察期间，分别有 81.9%和 62.0%的患有 2 型糖尿病和 CVD 的患者未接受内分泌或心脏病学就诊。
这些数据表明，在患有 2 型糖尿病和 CVD 的患者中，专家和抗糖尿病药物的使用不足，这些药物据报道可带来心血管获益。最近更新的指南和心血管结局试验结果对这些患者的管理模式的影响仍有待观察。
