Exploring the relationship between coronary heart disease and type 2 diabetes: a cross-sectional study of secondary prevention among diabetes patients

Background: Coronary heart disease (CHD) and stroke are the major causes of death among people with diabetes. Aim: To describe the prevalence and onset of CHD and stroke among patients with type 2 diabetes mellitus (T2DM) in primary care in Norway, and explore the quality of secondary prevention. De...

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Main Authors: Bjørn Gjelsvik, Anh Thi Tran, Tore J Berg, Åsne Bakke, Ibrahimu Mdala, Kjersti Nøkleby, John G Cooper, Tor Claudi, Karianne Fjeld Løvaas, Geir Thue, Sverre Sandberg, Anne K Jenum
Format: Article
Language:English
Published: Royal College of General Practitioners 2019-03-01
Series:BJGP Open
Subjects:
Online Access:https://bjgpopen.org/content/3/1/bjgpopen18X101636
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spelling doaj-841a9535662e453ebaa8cbf91a3196532020-11-25T00:19:45ZengRoyal College of General PractitionersBJGP Open2398-37952019-03-013110.3399/bjgpopen18X101636Exploring the relationship between coronary heart disease and type 2 diabetes: a cross-sectional study of secondary prevention among diabetes patientsBjørn Gjelsvik0Anh Thi Tran1Tore J Berg2Åsne Bakke3Ibrahimu Mdala4Kjersti Nøkleby5John G Cooper6Tor Claudi7Karianne Fjeld Løvaas8Geir Thue9Sverre Sandberg10Anne K Jenum11Department of General Practice, General Practice Research Unit (AFE), Institute of Health and Society, University of Oslo, Oslo, NorwayDepartment of General Practice, General Practice Research Unit (AFE), Institute of Health and Society, University of Oslo, Oslo, NorwayInstitute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, NorwayDepartment of Medicine, Stavanger University Hospital, Stavanger, NorwayDepartment of General Practice, General Practice Research Unit (AFE), Institute of Health and Society, University of Oslo, Oslo, NorwayDepartment of General Practice, General Practice Research Unit (AFE), Institute of Health and Society, University of Oslo, Oslo, NorwayNorwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, NorwayDepartment of Medicine, Nordland Hospital, Bodø, NorwayNorwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, NorwayDepartment of Global Public Health and Primary Care, University of Bergen, Bergen, NorwayLaboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, NorwayDepartment of General Practice, General Practice Research Unit (AFE), Institute of Health and Society, University of Oslo, Oslo, NorwayBackground: Coronary heart disease (CHD) and stroke are the major causes of death among people with diabetes. Aim: To describe the prevalence and onset of CHD and stroke among patients with type 2 diabetes mellitus (T2DM) in primary care in Norway, and explore the quality of secondary prevention. Design & setting: A cross-sectional study of data was undertaken from electronic medical records (EMRs) of 10 255 patients with T2DM in general practice. The study took place in five counties of Norway (Oslo, Akershus, Rogaland, Hordaland, and Nordland). Quality of care was assessed based on national guideline recommendations. Method: Summary statistics with adjustments and binary logistic regression models were used. Results: In total, 2260 patients (22.1%) had CHD and 759 (7.4%) had stroke. South Asians had significantly more CHD than ethnic Norwegians (29.5%, 95% confidence interval [CI] = 26.1 to 33.0 versus 21.5%, CI = 20.6 to 22.3) and other ethnic groups, and experienced onset of CHD or stroke at a mean of 7 years before Norwegians. In 47.9% of the patients, CHD was diagnosed before T2DM. Treatment target for low-density lipoprotein (LDL) cholesterol was reached for 30.0% and for systolic blood pressure (SBP) for 65.1% of the patients with CHD. Further, 20.9% of patients with CHD were present smokers, and only 5.0% of patients reached all four treatment targets (no smoking, HbA1c ≤7.0%, SBP <135 mmHg, LDL-cholesterol <1.8 mmol/l). Conclusion: The diagnosis of CHD preceded the diagnosis of T2DM in half of the patients. The prevalence of CHD was highest and onset earlier among ethnic South Asians. More intensive treatment of lipids, blood pressure, and smoking are needed in patients with T2DM and CHD.https://bjgpopen.org/content/3/1/bjgpopen18X101636type 2 diabetescoronary heart diseasestrokesecondary preventiongeneral practiceprimary care
collection DOAJ
language English
format Article
sources DOAJ
author Bjørn Gjelsvik
Anh Thi Tran
Tore J Berg
Åsne Bakke
Ibrahimu Mdala
Kjersti Nøkleby
John G Cooper
Tor Claudi
Karianne Fjeld Løvaas
Geir Thue
Sverre Sandberg
Anne K Jenum
spellingShingle Bjørn Gjelsvik
Anh Thi Tran
Tore J Berg
Åsne Bakke
Ibrahimu Mdala
Kjersti Nøkleby
John G Cooper
Tor Claudi
Karianne Fjeld Løvaas
Geir Thue
Sverre Sandberg
Anne K Jenum
Exploring the relationship between coronary heart disease and type 2 diabetes: a cross-sectional study of secondary prevention among diabetes patients
BJGP Open
type 2 diabetes
coronary heart disease
stroke
secondary prevention
general practice
primary care
author_facet Bjørn Gjelsvik
Anh Thi Tran
Tore J Berg
Åsne Bakke
Ibrahimu Mdala
Kjersti Nøkleby
John G Cooper
Tor Claudi
Karianne Fjeld Løvaas
Geir Thue
Sverre Sandberg
Anne K Jenum
author_sort Bjørn Gjelsvik
title Exploring the relationship between coronary heart disease and type 2 diabetes: a cross-sectional study of secondary prevention among diabetes patients
title_short Exploring the relationship between coronary heart disease and type 2 diabetes: a cross-sectional study of secondary prevention among diabetes patients
title_full Exploring the relationship between coronary heart disease and type 2 diabetes: a cross-sectional study of secondary prevention among diabetes patients
title_fullStr Exploring the relationship between coronary heart disease and type 2 diabetes: a cross-sectional study of secondary prevention among diabetes patients
title_full_unstemmed Exploring the relationship between coronary heart disease and type 2 diabetes: a cross-sectional study of secondary prevention among diabetes patients
title_sort exploring the relationship between coronary heart disease and type 2 diabetes: a cross-sectional study of secondary prevention among diabetes patients
publisher Royal College of General Practitioners
series BJGP Open
issn 2398-3795
publishDate 2019-03-01
description Background: Coronary heart disease (CHD) and stroke are the major causes of death among people with diabetes. Aim: To describe the prevalence and onset of CHD and stroke among patients with type 2 diabetes mellitus (T2DM) in primary care in Norway, and explore the quality of secondary prevention. Design & setting: A cross-sectional study of data was undertaken from electronic medical records (EMRs) of 10 255 patients with T2DM in general practice. The study took place in five counties of Norway (Oslo, Akershus, Rogaland, Hordaland, and Nordland). Quality of care was assessed based on national guideline recommendations. Method: Summary statistics with adjustments and binary logistic regression models were used. Results: In total, 2260 patients (22.1%) had CHD and 759 (7.4%) had stroke. South Asians had significantly more CHD than ethnic Norwegians (29.5%, 95% confidence interval [CI] = 26.1 to 33.0 versus 21.5%, CI = 20.6 to 22.3) and other ethnic groups, and experienced onset of CHD or stroke at a mean of 7 years before Norwegians. In 47.9% of the patients, CHD was diagnosed before T2DM. Treatment target for low-density lipoprotein (LDL) cholesterol was reached for 30.0% and for systolic blood pressure (SBP) for 65.1% of the patients with CHD. Further, 20.9% of patients with CHD were present smokers, and only 5.0% of patients reached all four treatment targets (no smoking, HbA1c ≤7.0%, SBP <135 mmHg, LDL-cholesterol <1.8 mmol/l). Conclusion: The diagnosis of CHD preceded the diagnosis of T2DM in half of the patients. The prevalence of CHD was highest and onset earlier among ethnic South Asians. More intensive treatment of lipids, blood pressure, and smoking are needed in patients with T2DM and CHD.
topic type 2 diabetes
coronary heart disease
stroke
secondary prevention
general practice
primary care
url https://bjgpopen.org/content/3/1/bjgpopen18X101636
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