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Specialist care benefitted medically complex type 2 diabetes
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Among patients with comorbid medical conditions recently diagnosed with type 2 diabetes, early endocrinologist care helped reduce cardiovascular events and death, according to recent study findings published in Diabetic Medicine.
“This study showed that Ontario’s primary care system is functioning as it should by providing good care for the majority of newly diagnosed patients with type 2 diabetes,” Gillian L. Booth, MD, MSc, of St. Michael’s Hospital in Ontario, said in a press release. “With more than a million people living with diabetes in Ontario, endocrinologists don’t expect, or necessarily need, to see every patient. We really wanted to look at who would stand to benefit from early specialist care and should be referred as soon as possible.”
Booth and colleagues used data from the Ontario Diabetes Database to identify 79,020 adults aged 30 years or older with newly diagnosed diabetes who were living in Ontario between April 1, 1998 and March 31, 2006. They sought to determine if early endocrinologist care would reduce the risk for CV complications. Participants were divided into two groups: those who received endocrinologist care for the first year of diagnosis and those who received primary care alone.
Primary endpoints were nonfatal acute myocardial infarction or CV heart disease death at 3 years. Secondary endpoints included outcome of major CV events or death from any cause, lower extremity amputation, end-stage renal disease and all of the outcomes individually.
The group receiving endocrinologist care was more likely to be medically complex, 46% of whom were determined to be medically complex, compared with the primary care group, 34% of whom were medically complex.
The researchers found that medication use at 1 year differed significantly between the two groups with the endocrinologist care group being more likely to receive a statin (P < .001), an ACE inhibitor or angiotensin receptor blocker (P <.001) and two or more glucose-lowering (P < .001) or blood pressure-lowering (P < .001) drugs compared with the primary care group.
Over a median follow-up of 3 years, 3,359 participants died, 934 were admitted for acute myocardial infarction, 496 for stroke, 82 underwent a non-traumatic amputation and 217 developed end-stage renal disease.
Among the participants who were medically complex, those in the endocrinologist group had a 10% lower incidence of the primary and secondary endpoints, 22% lower incidence of stroke and decreased mortality from CV heart disease and all causes compared with those in primary care.
“The earlier we can help provide targeted care to these patients, the better,” Booth said. “Our research will hopefully contribute to the efficiency of our health care system, ensuring people with diabetes are living healthy lives, as long as possible.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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