Prevalence of macrovascular disease amongst type 2 diabetic patients detected by targeted screening and patients newly diagnosed in general practice: the Hoorn Screening Study

Prevalence of macrovascular disease amongst type 2 diabetic patients detected by targeted screening and patients newly diagnosed in general practice: the Hoorn Screening Study. Spijkerman AM, Henry RM, Dekker JM, Nijpels G, Kostense PJ, Kors JA, Ruwaard D, Stehouwer CD, Bouter LM, Heine RJ. Institutes for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands. [email protected] OBJECTIVES: Screening for type 2 diabetes has been recommended and targeted screening might be an efficient way to screen. The aim was to investigate whether diabetic patients identified by a targeted screening procedure differ from newly diagnosed diabetic patients in general practice with regard to the prevalence of macrovascular complications. DESIGN: Cross-sectional population-based study. SETTING: Population study, primary care. SUBJECTS: Diabetic patients identified by a population-based targeted screening procedure (SDM patients), consisting of a screening questionnaire and a fasting capillary glucose measurement followed by diagnostic testing, were compared with newly diagnosed diabetic patients in general practice (GPDM patients). Ischaemic heart disease and prior myocardial infarction were assessed by ECG recording. Peripheral arterial disease was assessed by the ankle-arm index. Intima-media thickness of the right common carotid artery was measured with ultrasound. RESULTS: A total of 195 SDM patients and 60 GPDM patients participated in the medical examination. The prevalence of MI was 13.3% (95% CI 9.3-18.8%) and 3.4% (1.0-11.7%) in SDM patients and GPDM patients respectively. The prevalence of ischaemic heart disease was 39.5% (95% CI 32.9-46.5%) in SDM patients and 24.1% (15.0-36.5%) in GPDM patients. The prevalence of peripheral arterial disease was similar in both groups: 10.6% (95% CI 6.9-15.9%) and 10.2% (4.7-20.5%) respectively. Mean intima-media thickness was 0.85 mm (+/-0.17) in SDM patients and 0.90 mm (+/-0.20) in GPDM patients. The difference in intima-media thickness was not statistically significant. CONCLUSIONS: Targeted screening identified patients with a prevalence of macrovascular complications similar to that of patients detected in general practice, but with a lower degree of hyperglycaemi

An observational study of the medical events associated with clinician-initiated changes in treatment for essential hypertension

We report a retrospective longitudinal observational study of co-morbidities and medical events associated with initiations and changes in antihypertensive therapy in 475 hypertensive patients of a large general practice. The median follow-up time was 7.0 years for males and 7.2 years for females. The data showed a low frequency of appropriate lifestyle recommendations (<30%), a gender-bias in lifestyle recommendations against women and that more than half of all patients' blood pressure (BP) was uncontrolled when last seen. Nearly half of all patients had co-morbidities relevant to essential hypertension (EHT) at first treatment for EHT and more than 11% of patients had more than one such co-morbidity. Whilst there was an increase in usage of ACE inhibitors and calcium channel blockers (CCB) as first treatment for EHT, there was also evidence that the existence of relevant co-morbidities rationally accounted for the majority of that increase. There were 5176 medical events relevant to EHT associated with change of drug or dosage treatment of EHT and the study provided evidence that the occurrence of such relevant medical events can rationally account for the majority of changes to EHT treatment. The study suggests that whilst general practitioners may fail to promote lifestyle changes to their patients with EHT, there is evidence that, when examined in sufficient detail, general practitioners' decisions to initiate changes in antihypertensive therapy are in keeping with the evidence base