Early specialist care for diabetes: who benefits most? A propensity score-matched cohort study.
Diabet Med
; 33(1): 111-8, 2016 Jan.
Article
in En
| MEDLINE
| ID: mdl-25981183
ABSTRACT
AIMS:
To examine whether early endocrinologist care reduces the risk of cardiovascular complications among newly diagnosed patients with diabetes of differing complexity.METHODS:
We conducted a population-based propensity score-matched cohort study using provincial health data from Ontario, Canada. Adults (≥ 30 years) diagnosed with diabetes between 1 April 1998 and 31 March 2006 who received endocrinologist care in the first year of diagnosis were matched to a comparison group receiving primary care alone (N = 79 020) based on propensity scores and medical complexity (assigned using information on chronic conditions). Individuals were followed for 3- and 5-year outcomes, including non-fatal acute myocardial infarction or coronary heart disease death (primary endpoint), major cardiovascular events (acute myocardial infarction, stroke) or all-cause death, amputation and end-stage renal disease.RESULTS:
Among medically complex patients, early endocrinologist care was associated with a lower 3-year incidence of the primary endpoint (hazard ratio 0.89, 95% CI 0.78-1.01) and major cardiovascular events or all-cause death (hazard ratio 0.91, 95% CI 0.85-0.97). These effects persisted after accounting for a higher incidence of end-stage renal disease on follow-up and were greatest in those with ≥ 3 visits to an endocrinologist (primary endpoint hazard ratio 0.69, 95% CI 0.56-0.86 and 0.61, 95% CI 0.45-0.82, for unadjusted and end-stage renal disease adjusted analyses, respectively). In contrast, no benefit was observed in the non-medically complex subgroup. Overall effects were similar at 5 years.CONCLUSIONS:
Early endocrinologist care is associated with a lower incidence of cardiovascular events and death among newly diagnosed patients with diabetes who have comorbid medical conditions.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Specialization
/
Cardiovascular Diseases
/
Evidence-Based Medicine
/
Diabetes Mellitus, Type 2
/
Diabetic Angiopathies
/
Endocrinology
/
Diabetic Cardiomyopathies
Type of study:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adult
/
Female
/
Humans
/
Male
Country/Region as subject:
America do norte
Language:
En
Journal:
Diabet Med
Journal subject:
ENDOCRINOLOGIA
Year:
2016
Document type:
Article
Affiliation country:
Canadá