Cardiovascular risk management in type 2 diabetes of more than 10-year duration: Results of Polish ARETAEUS2-Grupa Study

Background: ARETAEUS 1 study showed that a great majority of patients with type 2 dia­betes mellitus (T2DM) of short duration did not meet all of the treatment goals. Since then the treatment goals in T2DM have been changed. The aim of the ARETAEUS 2-Grupa Study was to assess cardiovascular (CV) risk management and meeting treatment goals in the population of T2DM of more than 10-year duration. Methods: ARETAEUS2-Grupa was a cross-sectional questionnaire-based study conducted in Poland in 2012. Randomly selected physicians recruited 1,740 patients with T2DM diag­nosed more than 10 years before the study. Results: Lipid treatment goals were met respectively: for total cholesterol in 34.5% of all patients, triglycerides in 53.8%, low density lipoprotein cholesterol (LDL-C) in 26.5% and high density lipoprotein cholesterol (HDL-C) in 38.2%. Most of patients with and without coronary artery disease were receiving aspirin (90.3% and 60%, respectively) and statins (84.4% and 67.7%, respectively). The current blood pressure (BP) goal (140/90 mm Hg) was met in 43.5% of pa­tients and the previous goal (< 130/80 mm Hg) in 12.4%. The patients were mainly treated with ≥ 3 antihypertensive drugs. All treatment goals (for HbA1c, BP and LDL-C) were reached only by 8.2% of patients, any two goals by 26.3% of patients, one goal by 39.8% of patients, none by 25.6% of patients. Conclusions: The new less restrictive treatment goals are reached more frequently but still much is to be done in the field of clinical practice guidelines implementation and CV prevention in T2DM population

Trends for beta-blockers use in a large cohort of Polish hypertensive patients — Pol-Fokus Study

Background Beta-blockers remain one of the most frequently prescribed antihypertensive drug classes. The aim of the analysis was to evaluate characteristics of patients treated with beta-blockers and factors associated with the treatment of beta-blockers. Material and methods We analysed the data from the large cross-sectional study evaluating 12,375 patients treated for hypertension for at least one year. Results Overall, 7080 patients (57.2% of the whole group) were treated with beta-blockers. The rate of use of beta-blockers was higher in patients with diabetes (62.9 vs 55.6%), coronary artery disease (72.2 vs 46.4%), previous myocardial infarction (82.3 vs 54.1%), heart failure (73.1 vs 53.3%) and arrhythmias (73.1 vs 51.1%) than in patients without those conditions (all comparisons p < 0.001). Beta-blockers were used less frequently among patients with asthma/COPD than without asthma/COPD (54.0 vs 58.0%; p = 0.017). In patients aged 40 years and less, the compelling indications for these agents were found only in 21.7% of patients. In patients aged 40–65 years, none of compelling indications was found in 41.3% of patients. In patients 65 years or more, the most frequent compelling indications were coronary artery disease, previous myocardial infarction and heart failure, which were present in 70.1% of patients. Conclusions High utilization rate of beta-blockers in patients with hypertension, only second to renin-angiotensin blockers, has been shown. In middle age and, especially, in older patients it might reflect high cardiovascular burden of those patients, including coexistence of established cardiac disease. In younger patients beta-blockers are used more frequently with none of the compelling indications present

Management and treatment goals in Polish patients with type 2 diabetes of more than ten years’ duration — results of ARETAEUS2-Grupa Study

Wstęp: W poprzednich badaniach wykazano niewystarczającą kontrolę choroby u chorych na cukrzycę. Polskie Towarzystwo Diabetologiczne zmieniło wartości docelowe HbA1c i ciśnienia tętniczego u chorych na cukrzycę w wytycznych z 2011 roku, które zostały utrzymane w kolejnych edycjach wytycznych. Badanie przeprowadzono w celu oceny leczenia cukrzycy i wyboru metod leczenia u chorych na cukrzycę typu 2 o czasie trwania > 10 lat oraz określenia stopnia spełniania kryteriów kontroli cukrzycy zalecanych w wytycznych Polskiego Towarzystwa Diabetologicznego z 2012 roku.Materiał i metody: Badanie ARETAEUS2-Grupa było przekrojowym badaniem kwestionariuszowym przeprowadzonym w Polsce w 2012 roku (kwiecień–czerwiec). Badaniem objęto 1740 chorych na cukrzycę typu 2 w każdym wieku i obu płci rozpoznaną ponad 10 lat przed rozpoczęciem badania, włączonych do badania przez losowo wybranych lekarzy.Wyniki: Wszyscy chorzy otrzymywali leczenie farmakologiczne, większość — leczenie skojarzone lub insulinę w monoterapii. 40% chorych spełniło kryterium kontroli HbA1c (≤ 7%), a mediana odsetka HbA1c była powyżej zalecanej wartości (7,2%). W całej populacji jedynie 8% chorych spełniło wszystkie kryteria kontroli choroby (HbA1c, ciśnienie tętnicze i profil lipidowy), 26% — dwa z tych kryteriów, 40%— jedno z tych kryteriów. Ponad 25% chorych nie spełniło żadnego z tych kryteriów.Wnioski: Zaobserwowano duże odstępstwa od celów leczenia zalecanych w aktualnych wytycznych postępowania u chorych na cukrzycę typu 2 o czasie trwania > 10 lat. Częstość występowania sercowo-naczyniowych czynników ryzyka i późnych powikłań cukrzycy była duża, a stosunkowo duży odsetek chorych nie był badany w kierunku późnych powikłań cukrzycy.Introduction: Previous studies have shown insufficient diabetes control in patients with type 2 diabetes (T2DM). Diabetes Poland changed the target HbA1c and blood pressure (BP) values in diabetic patients in their practice guidelines in 2011, that were further sustained. To assess the management and treatment choices in T2DM of more than ten years’ duration and the degree to which diabetic control criteria recommended by the Diabetes Poland clinical practice guidelines 2012 are being met.Material and methods: ARETAEUS2-Grupa was a cross-sectional questionnaire-based study conducted in Poland in 2012 (April–June). It involved 1,740 patients of any age and both genders, with T2DM diagnosed more than ten years before the study, and recruited by randomly selected physicians.Results: All patients received pharmacological treatment, most of them combination therapy or insulin in monotherapy. 40% of patients met the goal for HbA1c control (≤ 7%) and the median value of HbA1c was above the recommended threshold (7.2%). Only 8% of thetotal population met all three goals (HbA1c, BP and lipid levels), 26% — two goals, and 40% — only one goal. Over 25% of patients did not meet any of the treatment goals.Conclusions: We observed considerable deviations from treatment targets recommended by current clinical practice guidelines for patients with T2DM of more than ten years’ duration. The frequency of cardiovascular risk factors and late diabetes complications was high, while a relatively high percentage of patients was not examined for late diabetes complications