The effectiveness and cost of single and multi-factorial cardiovascular risk factor modification to guideline targets in type 2 diabetes

• Published in: Primary care diabetes Vol. 6; no. 1; pp. 67 - 73
• Main Authors: Prescott, A, Bailey, J.E, Kelly, K.J, Munyombwe, T, Gray, A, Summers, L.K.M
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.04.2012
• Subjects: Cardiovascular disease; Cardiovascular Diseases - economics; Cardiovascular Diseases - mortality; Coronary Disease - economics; Coronary Disease - mortality; Cost-Benefit Analysis; Diabetes mellitus; Diabetes Mellitus, Type 2 - economics; Diabetes Mellitus, Type 2 - mortality; Diabetic Angiopathies - economics; Diabetic Angiopathies - mortality; Endocrinology & Metabolism; Female; Guidelines; Health Care Costs - statistics & numerical data; Humans; Internal Medicine; Male; Middle Aged; Morbidity; Myocardial Infarction - economics; Myocardial Infarction - mortality; Practice Guidelines as Topic; Risk Factors; Risk Reduction Behavior; Sex Distribution; Smoking - economics; Smoking - epidemiology; Stroke - economics; Stroke - mortality; United Kingdom - epidemiology; T2DM; LDL-C; Diabetes mellitus; QOF; Cardiovascular disease; high density lipoprotein cholesterol; Guidelines; HDL-C; Quality and Outcomes Framework; HbA 1C; Lipitor2687 cardiovascular risk calculator model; LCRP; Leeds Cardiovascular Risk Project; type 2 diabetes mellitus; UKPDS; NICE; Scottish Intercollegiate Guideline Network; SIGN; LIP2687; glycated haemoglobin; United Kingdom Prospective Diabetes Study; low density lipoprotein cholesterol; National Institute for Health and Clinical Excellence; HbA1C
• ISSN: 1751-9918; 1878-0210
• DOI: 10.1016/j.pcd.2011.12.001

Abstract Aims Cardiovascular disease is the main cause of morbidity and mortality in type 2 diabetes (T2DM), at huge cost to the NHS. We investigated the potential effect on population cardiovascular risk and associated costs of single and multi-factorial intervention, to target levels, in individuals with T2DM. Methods Baseline population means and proportions for cardiovascular risk factors were calculated for 159 patients with T2DM from 3 general practices. Predicted 10 year cardiovascular risk, and associated costs were calculated using the LIP2687 risk calculator, based on Framingham and UKPDS equations. Systolic blood pressure, HbA1C , total cholesterol and HDL-cholesterol were altered to NICE and SIGN target levels and the model run again. The difference in outcomes was observed. Results 45%, 76% and 38% of patients met NICE targets for cholesterol, systolic blood pressure and HbA1c, respectively. As expected, comparing the two guidelines, fewer patients met the ‘stricter’ targets ( P = 0.0001). Treatment-to-target produced no significant difference in cardiovascular risk or costs, although greater reductions in outcomes were seen with multi-factorial intervention. Conclusion This small study suggests that intervention in only those patients with the highest cardiovascular risk brings little reduction in population cardiovascular risk and associated health costs. Multi-factorial intervention in all patients with T2DM, regardless of baseline values, is likely to bring greater reductions. This raises the question as to whether the current emphasis on treatment to target should be modified to encourage multi-factorial intervention in all patients with T2DM, even those with baseline values below target levels.