Keywords: type 2 diabetes, cardiovascular risk, obesity, coronary artery disease, family medicine

Background:

Nowadays comprehensive approach in type 2 diabetes (T2D) treatment considers dual principle of simultaneous HbA1c regulation and cardiovascular (CV) risk control. In the recent decades, novel antidiabetic medications showed remarkable beneficial effects in terms of CV protection.

Research questions:

How high is the CV risk of individuals with T2D in Croatia?

Method:

This study gathered six GP practices from different Croatian regions. In the first part of the research, a detailed list of parameters needed for adequate CV risk assessment was established. Further, each researcher listed all individuals with T2D in their practice and briefly examined their each health record profile to collect data on CV risk assessment and medication used as well.

Results:

Obtained preliminary results consist of 501 individuals with T2D with an average of 8.5% per practice, most of whom were aged 60 to 80 years. Regarding the assessment of their CV risk, average BMI was 30.6 kg/㎡, WHR 1.0, HbA1c 7.0% and LDL cholesterol 2.7 mmol/l. Arterial hypertension was associated to over 80% of T2D cases, and coronary artery disease to around 30%. Reduced renal function (eGFR < 90 ml/min) was detected in 75% of cases, but only 18.4% with eGFR below 60 ml/min. Still, albuminuria occurred in 63.5%. Although cerebrovascular incident occurred in 5.6% of T2D individuals, 25% had significant carotid or vertebral artery stenosis. In terms of using antidiabetic medications, expectedly, metformin was prescribed in 81.4% of cases, followed with equal prescribing rates of DPP4ins and SGLT2ins of around 27%. GLP-1 RAs were prescribed in 11.8% of T2D individuals, nearly the same as basal insulin (11.4%). Prescribing rate of sulfonylurea medications was 9.9%, and the prandial insulin 5.4%.

Conclusions:

It is of utmost importance to evaluate CV risk factors of individuals with T2D and timely indicate adequate therapies with cardioprotective benefits.

Points for discussion:

Does CV risk in T2D individuals go under our radar?

Are prescription rates of novel, cardioprotective antidiabetic medications too low?

Which methods for optimization of CV risk assessment and T2D treatment should be implemented?