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The darkening cloud of diabetes: do trends in cardiovascular risk management provide a silver lining?

Eurich DT, Gamble JM, Simpson SH, Johnson JA - Diabetes Care (2008)

Bottom Line: During this period, both cerebrovascular and cardiac-related hospitalizations declined by 36% (9.5 vs. 6.1 per 1,000) and 19% (38.0 vs. 30.6 per 1,000) (P < 0.05 for trends), respectively, with similar reductions regardless of sex.No change in all-cause mortality was observed (17.7 vs. 17.8 deaths per 1,000; P > 0.05).Despite this, we observed no change in all-cause mortality.

View Article: PubMed Central - PubMed

Affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, Canada. deurich@ualberta.ca

ABSTRACT

Objective: We aimed to evaluate the changes in cardiovascular-related health care utilization (drug therapies, hospitalizations) and mortality for the diabetic population during a 9-year period in Saskatchewan, Canada.

Research design and methods: We identified annual diabetes prevalence rates for people aged >or=30 years between 1993 and 2001 from the administrative databases of Saskatchewan Health. Annual rates of evidence-based drug therapies (antihypertensives, ACE inhibitors, beta-blockers, calcium channel blockers, 3-hydroxy-3-metaglutaryl coenzyme A reductase inhibitors [statins]), hospitalizations for cerebrovascular and cardiac events, and all-cause mortality were estimated. Rates were direct age and sex standardized using the 2001 Canadian population, and trends over time were assessed using Joinpoint regression.

Results: From 1993 to 2001, diabetes prevalence increased 34% (4.7-6.5%, P < 0.001) with the highest rates in men and those aged >or=65 years. The rate of increase in diabetes prevalence appeared to slow in those aged <65 years (P < 0.01 for trend). Significant increased use of evidence-based drug therapies was observed (41% increase in antihypertensive agents, 97% increase in ACE inhibitors, 223% increase in statin therapies; all P < 0.05 for trend). During this period, both cerebrovascular and cardiac-related hospitalizations declined by 36% (9.5 vs. 6.1 per 1,000) and 19% (38.0 vs. 30.6 per 1,000) (P < 0.05 for trends), respectively, with similar reductions regardless of sex. No change in all-cause mortality was observed (17.7 vs. 17.8 deaths per 1,000; P > 0.05).

Conclusions: During our period of study, there was an increase in the utilization of evidenced-based drug therapies in people with diabetes and reductions in cardiovascular-related hospitalizations. Despite this, we observed no change in all-cause mortality.

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Overall direct age- and sex-standardized prescription rates between 1993 and 2001.
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f1: Overall direct age- and sex-standardized prescription rates between 1993 and 2001.

Mentions: Between 1993 and 2001, the number of people with at least one prescription claim for an antihypertensive agent increased significantly from 345.8 to 487.1 per 1,000 people with diabetes, respectively (Table 2) (Fig. 1). Although overall utilization increased during this period, utilization remained fairly constant between 1993 and 1996 (APC increase 1.5%, P > 0.05 for trend), but thereafter rates of antihypertensive use changed significantly with an APC increase of 6.3% (P < 0.001 for trend) (Table 2). The rate of change differed, however, by sex and age. Men had a substantially greater APC increase in utilization compared with women (6.3 vs. 3.7%), although overall utilization rates remained significantly lower for men in 2001 (sRR 0.92 [95% CI 0.89–0.96]) (Table 2). Similarly, higher utilization rates were observed in people aged ≥65 years irrespective of time period; however, those aged <65 years had a substantially greater APC increase compared with those aged ≥65 years (5.5 vs. 3.5%) (Table 2).


The darkening cloud of diabetes: do trends in cardiovascular risk management provide a silver lining?

Eurich DT, Gamble JM, Simpson SH, Johnson JA - Diabetes Care (2008)

Overall direct age- and sex-standardized prescription rates between 1993 and 2001.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2571063&req=5

f1: Overall direct age- and sex-standardized prescription rates between 1993 and 2001.
Mentions: Between 1993 and 2001, the number of people with at least one prescription claim for an antihypertensive agent increased significantly from 345.8 to 487.1 per 1,000 people with diabetes, respectively (Table 2) (Fig. 1). Although overall utilization increased during this period, utilization remained fairly constant between 1993 and 1996 (APC increase 1.5%, P > 0.05 for trend), but thereafter rates of antihypertensive use changed significantly with an APC increase of 6.3% (P < 0.001 for trend) (Table 2). The rate of change differed, however, by sex and age. Men had a substantially greater APC increase in utilization compared with women (6.3 vs. 3.7%), although overall utilization rates remained significantly lower for men in 2001 (sRR 0.92 [95% CI 0.89–0.96]) (Table 2). Similarly, higher utilization rates were observed in people aged ≥65 years irrespective of time period; however, those aged <65 years had a substantially greater APC increase compared with those aged ≥65 years (5.5 vs. 3.5%) (Table 2).

Bottom Line: During this period, both cerebrovascular and cardiac-related hospitalizations declined by 36% (9.5 vs. 6.1 per 1,000) and 19% (38.0 vs. 30.6 per 1,000) (P < 0.05 for trends), respectively, with similar reductions regardless of sex.No change in all-cause mortality was observed (17.7 vs. 17.8 deaths per 1,000; P > 0.05).Despite this, we observed no change in all-cause mortality.

View Article: PubMed Central - PubMed

Affiliation: School of Public Health, University of Alberta, Edmonton, Alberta, Canada. deurich@ualberta.ca

ABSTRACT

Objective: We aimed to evaluate the changes in cardiovascular-related health care utilization (drug therapies, hospitalizations) and mortality for the diabetic population during a 9-year period in Saskatchewan, Canada.

Research design and methods: We identified annual diabetes prevalence rates for people aged >or=30 years between 1993 and 2001 from the administrative databases of Saskatchewan Health. Annual rates of evidence-based drug therapies (antihypertensives, ACE inhibitors, beta-blockers, calcium channel blockers, 3-hydroxy-3-metaglutaryl coenzyme A reductase inhibitors [statins]), hospitalizations for cerebrovascular and cardiac events, and all-cause mortality were estimated. Rates were direct age and sex standardized using the 2001 Canadian population, and trends over time were assessed using Joinpoint regression.

Results: From 1993 to 2001, diabetes prevalence increased 34% (4.7-6.5%, P < 0.001) with the highest rates in men and those aged >or=65 years. The rate of increase in diabetes prevalence appeared to slow in those aged <65 years (P < 0.01 for trend). Significant increased use of evidence-based drug therapies was observed (41% increase in antihypertensive agents, 97% increase in ACE inhibitors, 223% increase in statin therapies; all P < 0.05 for trend). During this period, both cerebrovascular and cardiac-related hospitalizations declined by 36% (9.5 vs. 6.1 per 1,000) and 19% (38.0 vs. 30.6 per 1,000) (P < 0.05 for trends), respectively, with similar reductions regardless of sex. No change in all-cause mortality was observed (17.7 vs. 17.8 deaths per 1,000; P > 0.05).

Conclusions: During our period of study, there was an increase in the utilization of evidenced-based drug therapies in people with diabetes and reductions in cardiovascular-related hospitalizations. Despite this, we observed no change in all-cause mortality.

Show MeSH
Related in: MedlinePlus