Evidence mapPaperPMID 38436903Full record

Observational studyJournal of endocrinological investigation2024

Quality of care and clinical inertia in the management of cardiovascular risk factors in patients with type 1 and type 2 diabetes: data from AMD annals.

A Da Porto, R Candido, A Rocca, V Manicardi, A Nicolucci, C Miranda, E Cimino, P Di Bartolo, G Di Cianni, G Russo

Abstract readObservational StudyMulticenter Study
PubMed Publisher
In one paragraph

Observational study in Journal of endocrinological investigation, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
2.1field-weighted citation impact, top 12% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 6 citations in OpenAlex.

  1. Observational
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 8 institutions in 1 country.

A Da PortoDiabetes and Metabolism Unit, Clinica Medica, University of Udine, Udine, Italy. daporto.andrea@gmail.com.ORCID http://orcid.org/0000-0001-9995-0169
R CandidoDepartment of Medical Surgical and Health Sciences, University of Trieste, Diabetes Center, ASUGI, Trieste, Italy.
A Rocca"G. Segalini" H. Bassini Cinisello Balsamo ASST Nord, Milan, Italy.
V ManicardiAMD Foundation, Reggio Emilia, Italy.
A NicolucciCenter for Outcomes Research and Clinical Epidemiology-CORESEARCH, Pescara, Italy.
C MirandaEndocrinology and Diabetes Unit, ASFO, Pordenone, Italy.
E CiminoUOC Medicina Generale ad Indirizzo Metabolico e Diabetologico, ASST Spedali Civili of Brescia, Brescia, Italy.
P Di BartoloRavenna Diabetes Center-Romagna Local Health Authority, Ravenna, Italy.
G Di CianniUSL Tuscany Northwest Location Livorno, Diabetes and Metabolic Disease, Livorno, Italy.
G RussoDepartment of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia · ITAzienda Unità Sanitaria Locale Della Romagna · ITCenter for Outcomes Research and Clinical Epidemiology · ITOspedale Bassini · ITOspedale di Livorno · ITUniversity of Messina · ITUniversity of Trieste · ITUniversity of Udine · IT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCardiovascular disease is the leading cause of morbidity and mortality among patients with diabetes, and for this reason, all guidelines for CV risk management provide the same targets in controlling traditional CV risk factors in patients with type 1 or type 2 diabetes at equal CV risk class. Aim of our study was to evaluate and compare CV risk management in patients with type 1 and type 2 diabetes included in AMD Annals Database paying particular attention to indicators of clinical inertia.

methodsThis was a multicenter, observational, retrospective study of AMD Annals Database during year 2022. Patients with diabetes were stratified on the basis of their cardiovascular risk, according to ESC-EASD guidelines. The proportion of patients not treated with lipid-lowering despite LDL cholesterol > to 100 mg/dl or the proportion of patients not treated with antihypertensive drug despite BP > 140/90 mmhg and proportion of patients with proteinuria not treated with angiotensin converting enzyme inhibitors or angiotensinogen receptor blockers (ACE/ARBs) were considered indicators of clinical inertia. The proportion of patients reaching at the same time HbA1c < 7% LDL < 70 mg/dl and BP < 130/80 mmhg were considered to have good multifactorial control. Overall quality of health care was evaluated by the Q-score.

resultsUsing the inclusion criteria and stratifying patients by ESC/EASD Cardiovascular Risk categories, we included in the analysis 118.442 patients at High Cardiovascular risk and 416.246 patients at Very High Cardiovascular risk. The proportion of patients with good multifactorial risk factor control was extremely low in both T1D and T2D patients in each risk class. At equal risk class, the patients with T1D had lower proportion of subjects reaching HbA1c, LDL, or Blood Pressure targets. Indicators of clinical inertia were significantly higher compared with patients with T2D at equal risk class. Data regarding patients with albuminuria not treated with RAAS inhibitors were available only for those at Very High risk and showed that the proportion of patients not treated was again significantly higher in patients with T1DM.

conclusionsIn conclusion, this study provides evidence of wide undertreatment of traditional cardiovascular risk factors among patients with diabetes included in AMD Annals Database. Undertreatment seems to be more pronounced in individuals with T1D compared to those with T2D and is frequently due to clinical inertia.

Indexed as

Cardiovascular DiseasesDiabetes Mellitus, Type 1Diabetes Mellitus, Type 2Heart Disease Risk FactorsQuality of Health CareAgedFemaleHumansMaleMiddle AgedRetrospective StudiesRisk FactorsCardiovascular riskClinical inertiaDiabetesReal-world dataUndertreatment

Identifiers

PMID38436903
OpenAlexW4392378363

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.