Underuse of cardiorenal protective agents in high-risk diabetes patients in primary care: a cross-sectional study.

Autor: Hao R; Department of Medicine, University of Alberta, 13-103 Clinical Sciences Building, 11350-83 Avenue, Edmonton, Alberta, T6G 2G3, Canada., Myroniuk T; Department of Public Health, University of Missouri, 510 Lewis Hall, Columbia, MO, 65211, USA.; Physician Learning Program, Faculty of Medicine and Dentistry, University of Alberta, 2-590 Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, Alberta, T6G 1C9, Canada., McGuckin T; Physician Learning Program, Faculty of Medicine and Dentistry, University of Alberta, 2-590 Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, Alberta, T6G 1C9, Canada., Manca D; Physician Learning Program, Faculty of Medicine and Dentistry, University of Alberta, 2-590 Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, Alberta, T6G 1C9, Canada.; Department of Family Medicine, University of Alberta, Suite 5-16, University Terrace, 833 112 Street, Edmonton, Alberta, T6G 2T4, Canada., Campbell-Scherer D; Physician Learning Program, Faculty of Medicine and Dentistry, University of Alberta, 2-590 Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, Alberta, T6G 1C9, Canada.; Department of Family Medicine, University of Alberta, Suite 5-16, University Terrace, 833 112 Street, Edmonton, Alberta, T6G 2T4, Canada., Lau D; Department of Medicine, University of Alberta, 13-103 Clinical Sciences Building, 11350-83 Avenue, Edmonton, Alberta, T6G 2G3, Canada.; Physician Learning Program, Faculty of Medicine and Dentistry, University of Alberta, 2-590 Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, Alberta, T6G 1C9, Canada., Yeung RO; Department of Medicine, University of Alberta, 13-103 Clinical Sciences Building, 11350-83 Avenue, Edmonton, Alberta, T6G 2G3, Canada. ryeung@ualberta.ca.; Physician Learning Program, Faculty of Medicine and Dentistry, University of Alberta, 2-590 Edmonton Clinic Health Academy, 11405-87 Ave NW, Edmonton, Alberta, T6G 1C9, Canada. ryeung@ualberta.ca.; Division of Endocrinology & Metabolism, University of Alberta, 2-590 Edmonton Clinic Health Academy (ECHA) 11405-87 Ave NW, Edmonton, Alberta, T6G 1C9, Canada. ryeung@ualberta.ca.
Jazyk: angličtina
Zdroj: BMC primary care [BMC Prim Care] 2022 May 24; Vol. 23 (1), pp. 124. Date of Electronic Publication: 2022 May 24.
DOI: 10.1186/s12875-022-01731-w
Abstrakt: Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) have shown benefits in patients with diabetes and cardiovascular disease (CVD), heart failure (HF), and chronic kidney disease (CKD).
Objective: We assessed benchmark outcomes (Hemoglobin A1c, LDL-C, and blood pressure), identified the prevalence of cardiorenal indications for SGLT2i and GLP-1RA, and compared prescribing rates of GLP1-RA and SGLT2i in those with and without cardiorenal indications.
Methods: We analyzed data from January 2018-June 2019 for 7168 patients with diabetes using electronic medical records from the Northern Alberta Primary Care Research Network, a regional network of the Canadian Primary Sentinel Surveillance Network (CPCSSN). Patients with and without cardiorenal comorbidities were compared using descriptive statistics and two proportion Z tests.
Results: Hemoglobin A1c ≤ 7.0% was met by 56.8%, blood pressure < 130/80 mmHg by 62.1%, LDL-C ≤ 2.0 mmol/L by 45.3% of patients. There were 4377 patients on glucose lowering medications; metformin was most common (77.7%), followed by insulin (24.6%), insulin secretagogues (23.6%), SGLT2i (19.7%), dipeptidyl peptidase-4 inhibitor (19.3%), and GLP-1RA (9.4%). A quarter of patients had cardiorenal indications for SGLT2i or GLP-1RA. Use of SGLT2i in these patients was lower than in patients without cardiorenal comorbidities (14.9% vs 21.2%, p < 0.05). GLP-1RA use in these patients was 4.6% compared with 11% in those without cardiorenal comorbidities (p < 0.05).
Discussion: Contrary to current evidence and recommendations, SGLT2i and GLP1-RA were less likely to be prescribed to patients with pre-existing CVD, HF, and/or CKD, revealing opportunities to improve prescribing for patients with diabetes at high-risk for worsening cardiorenal complications.
(© 2022. The Author(s).)
Databáze: MEDLINE
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