Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
Diabetes Obes Metab. 2024 Nov;26(11):5358-5367. doi: 10.1111/dom.15899. Epub 2024 Aug 29.
To investigate whether the physician-encounter interval for patients with type 2 diabetes (T2D) can be optimized from 2-3 to 4-6 months among those with a calculated 10-year cardiovascular disease (CVD) risk score of less than 20% without compromising their long-term outcomes.
Using territory-wide public electronic medical records in Hong Kong, we emulated a target trial to compare the effectiveness of the physician-encounter intervals of 4-6 versus 2-3 months for T2D patients without prior CVDs and with a predicted risk for CVDs of less than 20% (i.e. those patients not in the high-risk category). Propensity score matching was used to emulate the randomization of participants at baseline, where 42 154 matched individuals were included for analysis. The marginal structural model was applied to estimate the hazard ratio (HR) for CVD incidence and all-cause mortality, the incidence rate ratio of secondary and tertiary care utilization, as well as the between-group differences in HbA1c, blood pressure and cholesterol levels.
During a follow-up period of up to 12 (average: 5.1) years, there was no significantly increased risk of CVD in patients with physician-encounter intervals of 4-6 months compared with those patients with physician-encounter intervals of 2-3 months (HR [95% confidence interval {CI}]: 1.01 [0.90, 1.14]; standardized 10-year risk difference [95% CI]: -0.1% [-0.7%, 0.6%]), nor for all-cause mortality (HR: 1.00 [0.84, 1.20]; standardized 10-year risk difference: -0.1% [-0.5%, 0.3%]). Additionally, there was no observable difference in the utilization of secondary and tertiary care or key clinical parameters between these two follow-up frequencies.
For T2D patients with a calculated 10-year CVD risk of less than 20%, the interval of regular physician encounters can be optimized from 2-3 to 4-6 months without compromising patients' long-term outcomes and saving substantial service resources in primary care.
探讨对于心血管疾病（CVD）10 年风险评分＜20%的 2 型糖尿病（T2D）患者，是否可将其就诊间隔从 2-3 个月优化至 4-6 个月，同时又不影响其长期结局。
我们利用香港地区的全民电子病历数据进行模拟试验，比较无 CVD 病史且预测 CVD 风险＜20%（即不属于高危人群）的 T2D 患者的 4-6 个月和 2-3 个月就诊间隔的效果。采用倾向评分匹配法在基线水平模拟参与者的随机分组，共纳入 42154 例匹配个体进行分析。采用边缘结构模型估计 CVD 发病和全因死亡率、二级和三级保健利用率的发病率比值，以及组间 HbA1c、血压和胆固醇水平的差异。
在最长达 12 年（平均：5.1 年）的随访期间，与 2-3 个月就诊间隔相比，4-6 个月就诊间隔并未显著增加患者的 CVD 发病风险（风险比[95%置信区间]：1.01[0.90，1.14]；标准化 10 年风险差异[95%置信区间]：-0.1%[-0.7%，0.6%]），也不增加全因死亡率（风险比：1.00[0.84，1.20]；标准化 10 年风险差异：-0.1%[-0.5%，0.3%]）。此外，两种随访频率之间在二级和三级保健或关键临床参数的利用率方面也无明显差异。
对于 CVD 10 年风险评分＜20%的 T2D 患者，可将常规就诊间隔从 2-3 个月优化至 4-6 个月，而不会影响患者的长期结局，并在初级保健中节省大量服务资源。
