Impact of a multifactorial treatment programme on clinical outcomes and cardiovascular risk estimates: a retrospective cohort study from a specialised diabetes centre in Denmark

Objectives To investigate the impact of a multifactorial treatment programme in a real-life setting on clinical outcomes and estimated cardiovascular disease (CUD) risk. Design A retrospective observational cohort study, using data from the electronic medical records and national registers. Setting Tertiary diabetes centre in Denmark. Participants Patients with type 2 diabetes (n=4299) referred to a programme with focus on treatment of hyperglycaemia, hypertension and dyslipidaemia between 1 January 2001 and 1 April 2016. Outcomes Primary outcomes were changes in haemoglobin A1c (HbA(1c)), blood pressure (BP) and low density lipoprotein (LDL) cholesterol as well as proportion reaching treatment targets. Our secondary outcome was to investigate changes in antidiabetic, antihypertensive and lipid-lowering treatment, together with the impact on estimated CUD risk. Linear mixed model for repeated measurements were used for continuous variables and logistic regression for dichotomous variables. Results The patients achieved a mean +/- SD decrease in HbA(1c), systolic and diastolic BP arid LDL cholesterol of 1.0%+/- 0.04% (10.6 +/- 0.4 mmol/mol), 6.3 +/- 0.4 mm Hg, 2.7 +/- 0.2 mm Hg and 0.32 +/- 0.02 mmol/L, respectively (p<0.0001). The proportion of patients who met the treatment goal for HbA(1c) (<7% (<53 mmol/mol)) increased from 31% to 58% (p<0.0001); for BP (<130/80 mm Hg) from 24% to 34% (p<0.0001), and for LDL cholesterol (<2.5 mmol/L (patients without previous CUD) or <1.8 mmol/L (patients with previous CUD)) from 52% to 65%. Those reaching all three guideline treatment targets increased from 4% to 15% (p<0.0001), and when relaxing the BP target to <140/85 from 8% to 24%. The estimated CVD risk was relatively reduced by 15.2% using the Swedish National Diabetes Register risk engine and 30.9% using the UK Prospective Diabetes Study risk engine. Conclusions Our data support that short-term multifactorial treatment of patients with glycaemic dysregulation in a specialist outpatient setting is both achievable and effective, arid associated with a clinically meaningful improvement in CVD risk.