Quality improvement opportunities for patients with diabetes and CVD

Using general practice data to identify where care can be improved

Quality improvement opportunities for patients with diabetes and CVD

The relationship between diabetes and increased risk of mortality from cardiovascular disease (CVD) is well established. What opportunities still remain in general practice to identify at risk patients and optimise their management?

In Australia almost two-thirds of the people who die from cardiovascular disease (CVD) also have diabetes or pre-diabetes.1

Risk factors for CVD such as hypertension and dyslipidaemia are commonly observed in people diagnosed with type 2 diabetes, and diabetes itself confers independent elevated CVD risk.2

Managing multiple CV risk factors rather than treating individual risk factors alone is encouraged, and is a crucial part of diabetes care.3,4 Alongside tight glycaemic control, guidelines recommend that patients with both type 2 diabetes and a history of established CVD be simultaneously treated with an antiplatelet (or anticoagulant), lipid-lowering and blood pressure (BP)-lowering therapy.3,4

However, despite the significantly elevated risk, studies in Australian primary care have reported that

  • patients with diabetes do not meet guideline recommended treatment targets for managing cardiovascular risk and
  • prescribing of recommended medicines for this patient cohort is suboptimal.5

In addition to pharmacological management, people with diabetes require continuous and systematic monitoring of blood glucose, BP, lipid and renal function targets to help direct management strategies, and detect diabetes complications.4

 

Using general practice data to drive better patient outcomes

To better understand how Australians with diabetes and CVD are being managed in primary care, a cross-sectional study was conducted using MedicineInsight data from participating Australian general practices.6

Patients aged 18 years or older, who presented to a practice at least three times in the two years before 1 November 2018 and had a diagnosis of type 2 diabetes and atherosclerotic CVD were included (n = 33,559) and their records assessed.

The study identified the following areas within MedicineInsight general practices where improvements to clinical practices and processes could support better outcomes for patients diagnosed with type 2 diabetes and CVD.

  • Prescribing recommended medicines: Only around two-thirds of patients had records indicating all three recommended medicines (BP-lowering, lipid-modifying and antiplatelet or anticoagulant medicines) were being prescribed to manage CVD risk (65.0%; 95% CI: 64.0, 66.0).6
  • Monitoring of risk factors: Guideline-recommended individual risk factor monitoring for BPa, LDL–Cb and HbA1ca was reported in 72.3%, 62.5% and 59.3% of patients, respectively.6
  • Achieving guideline-recommended treatment targets: Records showed a low proportion of patients with type 2 diabetes and CVD achieving general guideline recommended targets for BPa (44.3% <140/90 mm Hg), LDL-Cb (30% <1.8 mmol/L) and HbA1ca (33.1% ≤53 mmol/L).6

The management of people diagnosed with diabetes and CVD can be complex and requires a coordinated effort across the continuum of healthcare professionals and services. Having real-word data such as these presented in this MedicineInsight study can help promote discussion and encourage practice level reflection by GPs to support quality improvement measures for their individual patients.

Read the full article: Management of patients with type 2 diabetes and cardiovascular disease in primary care

LDL-C = low-density lipoprotein cholesterol; HbA1c = glycated haemoglobin; a = based on measurements recorded in the past six months; b = based on measurements recorded in the past 12 months

 

About MedicineInsight

MedicineInsight is a national general practice data program that extracts longitudinal, de-identified patient data from the clinical information systems (CISs) of participating general practices. It is developed and managed by NPS MedicineWise with funding support from the Australian Government Department of Health.

Find out more about MedicineInsight

This study was part of a larger project designed, developed and conducted by NPS MedicineWise with complete independence. Boehringer Ingelheim Pty Limited and Eli Lilly Australia Pty Limited supported the project with an unrestricted educational grant to VentureWise Pty Limited. VentureWise Pty Ltd was an independently run, wholly owned commercial subsidiary of NPS MedicineWise.

 

References

  1. Shaw, J and Tanamas, S, Diabetes: the silent pandemic and its impact on Australia 2012, Baker IDI Heart and Diabetes Institute, Diabetes Australia, Juvenile Diabetes Research Institute.
  2. Low Wang CC, Hess CN, Hiatt WR, Goldfine AB. Clinical update: Cardiovascular disease in diabetes mellitus: Atherosclerotic cardiovascular disease and heart failure in type 2 diabetes mellitus – Mechanisms, management, and clinical considerations. Circulation 2016;133(24):2459–502
  3. Baker IDI Heart and Diabetes Institute, National Evidence-Based Guideline on Secondary Prevention of Cardiovascular Disease in Type 2 Diabetes (Part of the Guidelines on Management of Type 2 Diabetes). 2015: Melbourne Australia
  4. The Royal Australian College of General Practitioners. Management of type 2 diabetes: A handbook for general practice. East Melbourne, Vic 2020.
  5. Chalasani S, Peiris DP, Usherwood T et al. Reducing cardiovascular disease risk in diabetes: a randomised controlled trial of a quality improvement initiative. Med J Aust. 2017;206(10):436-41.
  6. Marson A, Raffoul N, Osman R et al. Management of patients with type 2 diabetes and cardiovascular disease in primary care. Aust J Gen Pract 2021; 50: 238 – 50.