The Diabetes Shared Care Program and Risks of Cardiovascular Events in Type 2 Diabetes

Journal: 

Am J Med

publication year: 

2015

publication volume/issue: 

128(9)

publication page: 

977-985

First author: 

Correspondence: 

Abstract: 

OBJECTIVE:
The Diabetes Shared Care Program (DSCP) is an integrated diabetes care model designed to increase the quality of diabetes care in Taiwan. The efficacy of this program is unknown. Therefore, we evaluated whether participating patients had reduced risks of cardiovascular events, including coronary heart disease, stroke, and all-cause mortality.

METHODS:
All 120,000 diabetes patients' data in this retrospective-cohort study were obtained from the Taiwan's National Health Insurance Research Database. DSCP participants received integrated care from physician, diabetes educator, and dietitian. Otherwise, non-DSCP participants visited a physician without instruction from a diabetes educator or dietitian. We followed these patients until the first hospitalizations due to cardiovascular events. The Kaplan-Meier method was used to estimate the survival curves and the Cox proportional hazards model was applied to determine the risk of cardiovascular events.

RESULTS:
A total of 4,458 participants and 4,458-matched controls were enrolled in this study. Mean age of both participants and non-participants was 56 years-old. DSCP participants had significantly lower risks of cardiovascular events (HR 0.86, 95% CI 0.78 to 0.95), including stroke (HR 0.84, 95% CI 0.73 to 0.98), and all-cause mortality (HR 0.78, 95% CI 0.63 to 0.95) compared with non-participants. Older age, male, history of hypertension, chronic lung disease, and prescription for insulin secretagogues or insulin tended to have higher cardiovascular risks. Nevertheless, the following drugs reduced the cardiovascular risks: biguanides, alpha-glucosidase inhibitors, and thiazolidinediones.

CONCLUSIONS:
Participation in the DSCP was associated with lower risks of cardiovascular events, stroke, and all-cause mortality.