Urgent action needed to improve dysglycemia screening in patients with heart disease
medwireNews: More than half of people with coronary artery disease (CAD) have impaired glucose tolerance (IGT), yet many are unaware of this or are undertreated despite knowledge of their condition, results of the EUROASPIRE V survey show.
Lars Rydén (Karolinska Institutet, Stockholm, Sweden) and co-investigators therefore call for “[u]rgent action […] for both screening and management of patients with CAD and dysglycemia, in the expectation of a substantial reduction in risk of further cardiovascular events, complications of diabetes, and longer life expectancy.”
The study, which is part of the European Society of Cardiology’s European Observational Research Programme, included data for 8261 people aged 18–80 years with CAD (71% men) from 27 countries.
Of these, 2452 (29.7%) had known diabetes and the remainder were eligible for an oral glucose tolerance test (OGTT) to identify dysglycemia, defined as IGT or type 2 diabetes.
In all, 4440 participants received an OGTT, of whom 24.7% had IGT and 16.4% had newly diagnosed type 2 diabetes, giving a dysglycemia detection rate of 41.1%.
When these patients were added to those with known type 2 diabetes, the overall dysglycemia rate in the cohort was 51.8%. By comparison, the rate of normoglycemia was 24.5%, with an additional 7.2% having impaired fasting glucose and the remainder untested.
The participants also underwent glycated hemoglobin level testing, but the researchers calculated that without the OGTT, 30.0% of patients with type 2 diabetes and 69.8% of those with IGT would not have been detected.
In spite of this, Rydén et al say that spending 2 hours on an OGTT is often considered “a waste of time.” They believe, however, “[i]t is just one crucial investigation to characterize the cardiometabolic risk of a vulnerable coronary patient population leading to appropriate lifestyle and therapeutic management to improve prognosis.”
Regarding lifestyle, more than 80% of the patients with dysglycemia were overweight or obese, more than 65% reported that they did not take part in the recommended levels of physical activity (≥30 min 5 times/week), and 16–17% were current smokers.
Writing in Diabetes Care, Rydén and co-authors describe these findings as “strikingly poor” and say they “reflect the absence” of diabetes education services for most of these patients.
Indeed, just 30.8% of the people with previously known diabetes had been advised to attend a diabetes education program and just 24.1% actually attended.
The researchers also highlight that “current pharmacological management of these patients falls far short of guideline recommendations.” Specifically, both low-density lipoprotein cholesterol and blood pressure fell short of targets in a large proportion of patients, despite the availability of cholesterol-lowering and antihypertensive drugs. And just 58% of the people with known diabetes were receiving cardioprotective drugs from all four classes.
Rydén and team conclude that continually updating guidelines for patients with CAD “without addressing implementation and ensuring that lifestyle, risk factor, and therapeutic targets are being achieved in every day practice is a job half done.”
They say: “Much more resource and effort needs to be invested in implementing what we already know. To do so will result in better future health for many cardiometabolic patients.”
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