Structured diabetes care routines in cardiac rehabilitation are associated with increased diabetes detection and improved treatment after myocardial infarction: a nationwide observational study.

IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Cardiovascular Diabetology Pub Date : 2024-09-03 DOI:10.1186/s12933-024-02425-6
Bashaaer Sharad, Nils Eckerdal, Martin Magnusson, Halldora Ögmundsdottir Michelsen, Amra Jujic, Matthias Lidin, Linda Mellbin, Nael Shaat, Ronnie Pingel, John Wallert, Emil Hagström, Margrét Leósdóttir
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Abstract

Background: Despite the detrimental impact of abnormal glucose metabolism on cardiovascular prognosis after myocardial infarction (MI), diabetes is both underdiagnosed and undertreated. We investigated associations between structured diabetes care routines in cardiac rehabilitation (CR) and detection and treatment of diabetes at one-year post-MI.

Methods: Center-level data was derived from the Perfect-CR survey, which evaluated work routines applied at Swedish CR centers (n = 76). Work routines involving diabetes care included: (1) routine assessment of fasting glucose and/or HbA1c, (2) routine use of oral glucose tolerance test (OGTT), (3) having regular case rounds with diabetologists, and (4) whether glucose-lowering medication was adjusted by CR physicians. Patient-level data was obtained from the national MI registry SWEDEHEART (n = 7601, 76% male, mean age 62.6 years) and included all post-MI patients irrespective of diabetes diagnosis. Using mixed-effects regression we estimated differences between patients exposed versus. not exposed to the four above-mentioned diabetes care routines. Outcomes were newly detected diabetes and the proportion of patients receiving oral glucose-lowering medication at one-year post-MI.

Results: Routine assessment of fasting glucose/HbA1c was performed at 63.2% (n = 48) of the centers, while 38.2% (n = 29) reported using OGTT for detecting glucose abnormalities. Glucose-lowering medication adjusted by CR physicians (n = 13, 17.1%) or regular case rounds with diabetologists (n = 7, 9.2%) were less frequently reported. In total, 4.0% of all patients (n = 304) were diagnosed with diabetes during follow-up and 17.9% (n = 1361) were on oral glucose-lowering treatment one-year post-MI. Routine use of OGTT was associated with a higher rate of newly detected diabetes at one-year (risk ratio [95% confidence interval]: 1.62 [1.26, 1.98], p = 0.0007). At one-year a higher proportion of patients were receiving oral glucose-lowering medication at centers using OGTT (1.22 [1.07, 1.37], p = 0.0046) and where such medication was adjusted by CR physicians (1.31 [1.06, 1.56], p = 0.0155). Compared to having none of the structured diabetes care routines, the more routines implemented the higher the rate of newly detected diabetes (from 0 routines: 2.7% to 4 routines: 6.3%; p for trend = 0.0014).

Conclusions: Having structured routines for diabetes care implemented within CR can improve detection and treatment of diabetes post-MI. A cluster-randomized trial is warranted to ascertain causality.

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心肌梗死后,心脏康复中结构化的糖尿病护理常规与糖尿病检测率的提高和治疗效果的改善有关:一项全国范围的观察性研究。
背景:尽管糖代谢异常对心肌梗死(MI)后的心血管预后有不利影响,但糖尿病的诊断和治疗都不足。我们研究了心脏康复(CR)中结构化糖尿病护理常规与心肌梗死后一年糖尿病的检测和治疗之间的关系:中心层面的数据来自 Perfect-CR 调查,该调查评估了瑞典 CR 中心(n = 76)采用的工作常规。涉及糖尿病护理的工作常规包括(1) 空腹血糖和/或 HbA1c 的常规评估;(2) 口服葡萄糖耐量试验 (OGTT) 的常规使用;(3) 定期与糖尿病专家进行病例查房;(4) CR 医生是否调整降糖药物。患者层面的数据来自全国心肌梗死登记处 SWEDEHEART(n = 7601,76% 为男性,平均年龄 62.6 岁),包括所有心肌梗死后患者,无论其是否确诊为糖尿病。我们采用混合效应回归法估算了接触与未接触上述四种糖尿病护理常规的患者之间的差异。结果是在心肌梗死后一年新发现的糖尿病患者和接受口服降糖药的患者比例:63.2%的中心(n = 48)对空腹血糖/HbA1c进行了常规评估,38.2%的中心(n = 29)报告使用OGTT检测血糖异常。由 CR 医生调整降糖药物(13 人,17.1%)或与糖尿病专家定期进行病例查房(7 人,9.2%)的报告较少。总共有 4.0% 的患者(n = 304)在随访期间被诊断出患有糖尿病,17.9% 的患者(n = 1361)在心肌梗死一年后接受了口服降糖治疗。常规使用 OGTT 与一年后新发现糖尿病的比例较高有关(风险比 [95% 置信区间]:1.62 [1.26, 1.98],p = 0.0007)。一年后,在使用 OGTT(1.22 [1.07, 1.37],p = 0.0046)和由 CR 医生调整药物的中心,接受口服降糖药的患者比例更高(1.31 [1.06, 1.56],p = 0.0155)。与没有结构化糖尿病护理常规相比,实施的常规越多,新发现糖尿病的比例越高(从 0 个常规:2.7% 到 4 个常规:6.3%;趋势 p = 0.0014):结论:在 CR 中实施糖尿病护理的结构化例行程序可改善对心肌梗死后糖尿病的检测和治疗。结论:在 CR 中实施结构化的糖尿病护理常规可改善对心肌梗死后糖尿病的检测和治疗,有必要进行分组随机试验以确定因果关系。
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来源期刊
Cardiovascular Diabetology
Cardiovascular Diabetology 医学-内分泌学与代谢
CiteScore
12.30
自引率
15.10%
发文量
240
审稿时长
1 months
期刊介绍: Cardiovascular Diabetology is a journal that welcomes manuscripts exploring various aspects of the relationship between diabetes, cardiovascular health, and the metabolic syndrome. We invite submissions related to clinical studies, genetic investigations, experimental research, pharmacological studies, epidemiological analyses, and molecular biology research in this field.
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