Challenges in preventing cardiovascular complications in type 2 diabetes in primary care

Abstract

Background: Prevalence of type 2 diabetes mellitus (DM2) continues to increase worldwide. The associated cardiovascular morbidity and mortality are high. Objectives: To study daily practice in preventing cardiovascular disease (CVD) in an unselected primary care patient population with DM2, and to study factors influencing the care delivered. Methods: Cross-sectional univariate and multivariate analyses of baseline data from a primary care population-based sample of patients with DM2, participating in a shared care project in the Netherlands. Results: Of 1269 patients invited, 1149 (91%) participated. Hypertension was present in 78% of patients, 63 % of whom were treated, 41 % successfully. Lipid profile abnormalities were present in 51% of patients, 22% of whom were treated, 54% successfully. The treatment rates for lipid profile abnormalities were positively correlated with younger age and the registration of the lipid profile by the GP. For hypertension the treatment rates were higher for patients who were female, of an advanced age, in the presence of CVD, and/or whose blood pressure had been registered by the GP. Conclusion: A gap exists between recommended care and the care patients actually receive in the prevention of CVD in patients with DM2 in the primary care setting. Diagnosed CVD and the accurate registration of cardiovascular risk factors by GPs are associated with higher treatment rates. Improvement strategies could be directed at primary prevention of CVD and improving the registration of cardiovascular risk factors.