Collaborative type 2 diabetes care model has lasting benefits
medwireNews: Ten-year results from the Beijing Community Diabetes Study (BCDS) indicate that collaborative care delivered by primary care providers and specialists may result in sustained improvements in cardiovascular (CV) risk factor control among people with type 2 diabetes.
Mingxia Yuan (Capital Medical University, Beijing, China) told delegates at the 55th EASD Annual Meeting in Barcelona, Spain, that adult participants from 14 centers in the region were enrolled in a supervised collaborative management program in which 150 primary care providers worked together with specialists to improve type 2 diabetes management.
Yuan reported that average glycated hemoglobin (HbA1c) levels among 1550 people who completed follow-up decreased significantly from 7.35% at baseline to 7.06% at the 3-year follow-up, and this significant improvement was maintained at the 10-year follow-up, when average HbA1c levels were 7.10%.
Moreover, the proportion of individuals reaching target levels for HbA1c (<7.0%), blood pressure (<130/80 mmHg), and low-density lipoprotein (LDL) cholesterol (<2.6 mmol/L) rose significantly from 5.8% at baseline to 9.8% at 3 years and 18.6% at 10 years.
The investigators found that sustained control of these three CV risk factors at target levels over 10 years was associated with a significant reduction in all-cause mortality and CV events, with hazard ratios (HRs) of 0.275 and 0.582, respectively.
In an analysis of the number needed to treat, Yuan and team demonstrated that 14 people with type 2 diabetes would need to achieve persistent targeted control of the three CV risk factors to prevent one death, while 16 individuals would need to achieve risk factor control to prevent one CV event.
The BCDS investigators also evaluated neck circumference (NC) as a predictor of CV risk over the 10-year study, finding that men with an NC of 41 cm or bigger and women with an NC of at least 37 cm had a significantly higher risk than their counterparts with smaller NCs after adjustment for factors including age, diabetes duration, HbA1c, and baseline CV disease (HR=1.36).
Noting that the association between NC – a marker of upper body subcutaneous adipose tissue distribution – and CV disease remains controversial, presenting author Guangran Yang (Capital Medical University) said that waist circumference (≥90 cm in men and ≥85 cm in women) was also associated with CV risk, with an adjusted HR of 1.34.
She concluded that higher neck and waist circumference “might increase the risk for [CV disease] events by about 35% in Beijing communities.”
Discussing the clinical and societal implications of the BCDS results, Linong Ji (Peking University People’s Hospital, Beijing) said that the findings “clearly show” that CV risk factor control through a collaborative care model is beneficial.
“If diabetes could be properly managed as was shown by the BCDS study, the early death rate and mortality rate due to diabetes will be greatly reduced” in China, he added.
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