Management outcomes of patients with type 2 diabetes: targeting the 10-year absolute risk of coronary heart disease.

OBJECTIVE: To assess the management of patients with type 2 diabetes mellitus in the primary care setting, with respect to risk factors associated with coronary heart disease.

DESIGN: Retrospective cross-sectional audit.

SETTING: Specialised diabetes assessment clinic in a tertiary referral teaching hospital.

PARTICIPANTS: 328 patients with type 2 diabetes mellitus (mean age, 58.3 years [95% CI, 57.5-59.1]) and no existing coronary heart disease (CHD) referred to the clinic by general practitioners during 2004-2005.

MAIN OUTCOME MEASURES: Comparison of glycated haemoglobin (HbA(1c)), systolic blood pressure and total cholesterol levels and smoking frequency with current RACGP (Royal Australian College of General Practitioners) targets (< 7.0%; < 130/80 mmHg; < 4 mmol/L; and smoking cessation, respectively). Estimation of patients' 10-year absolute risk of CHD events using the United Kingdom Prospective Diabetes Study risk engine, and its relation to primary prevention of CHD.

RESULTS: 42%, 61% and 43% of patients were receiving medication to treat hyperglycaemia, hypertension and hypercholesterolaemia, respectively; 46%, 29% and 15% of patients, respectively, had [corrected] achieved the recommended RACGP target values for HbA1c, blood pressure, and total cholesterol; and 22% of patients were current smokers. The mean 10-year absolute risk of CHD was 16.8% (95% CI, 15.7%-17.9%), and 48% of patients were classified as "high risk" (absolute risk, > 15%). Based on the 10-year absolute risk, there was no difference between high- and low-risk groups with respect to prescription of aspirin, statins or angiotensin-converting enzyme inhibitors. If all the recommended RACGP goals were achieved, the mean 10-year absolute risk would decrease to 12.6% (95% CI, 11.8%-13.4%).

CONCLUSIONS: Recommended treatment targets are not being uniformly achieved. Medication for primary CHD prevention is not being preferentially directed at those patients at highest risk, based on the estimated 10-year absolute risk of CHD events. Our findings suggest new initiatives are required in the way target goals and primary CHD prevention measures are set for patients with type 2 diabetes mellitus.