UNSPECIFIED. (2004) Recalculation of cardiovascular risk score as a surrogate marker of change in clinical care of diabetes patients: the Alphabet POEM project (Practice of Evidence-based Medicine). CURRENT MEDICAL RESEARCH AND OPINION, 20 (5). pp. 765-772. ISSN 0300-7995

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Abstract

Aims: To assess the impact of evidence-based strategies on the care of subjects with diabetes, in particular on their coronary heart disease (CHD) risk, using the Alphabet Strategy template and coronary heart disease (CHD) risk calculators as novel audit tools.

Methods: Diabetes and cardiovascular parameters were collected on 400 consecutive type 2 diabetes patients attending the outpatient clinic. The subjects were men and women aged 21-75 years with necessary follow-up data from referral or first chronological available letter in the notes (T-fu) to the most recent follow-up visit (T-0). The average follow-up period was 5 years. Absolute CHD risk was calculated using the Framingham risk function and the United Kingdom Prospective Diabetes Study (UKPDS) risk engine. The results were analysed using Student's paired t-test and chi-squared test.

Results (T-0 vs. T-fu): Advice: smoking status improved 18.3 vs. 15.5%: p = 0.3. Blood pressure: systolic blood pressure improved 145.8 +/- 21.1 vs. 140.1 +/- 20.5 mmHg: p < 0.0001. Diastolic blood pressure improved 82.0 +/- 12.2 vs. 76.5 +/- 11.0 mmHg: p < 0.0001. Cholesterol: total cholesterol improved 5.8 +/- 1.6 vs. 4.9 +/- 1.0 mmol/L p < 0.0001; high density lipoprotein (HDL) cholesterol improved 1.05 vs. 1.26 mmol/L p < 0.001. Diabetes control: glycated haemoglobin (HbAlc)% worsened 7.9 +/- 1.8 vs. 8.1 +/- 1.5: p < 0.0001. However, when adjusted for duration of diabetes, this improved non-significantly by 12% overall. Eye examination: improved 86.5 vs. 97.5%: p < 0.001. Feet examination: improved 69.8 vs. 83.5%: p < 0.001. Guardian drugs: significantly more patients were on aspirin (29.0 vs. 83.5%: p < 0.001), angiotensin converting enzyme (ACE) inhibitors (32.0 vs. 64.5%: p < 0.001), and lipid lowering therapy (16.8 vs. 55.0%: p < 0.001). Heart disease risk scores: a significant reduction in Framingham 10-year absolute cardiac risk was achieved (20.6 +/- 10.04% vs. 16.7 +/- 9.1%: p = 0.001). Using the UKPDS risk engine, there was a non-significant reduction in absolute CHID risk over the follow-up period (23.8 +/- 14.8% vs. 23.7 +/- 15.5: p = NS). There were significant improvements between age-adjusted risk score (T-adj) and follow-up values (T-fu) (Framingham: 23.67% (T-adj) vs. 16.7% (T-fu); UKPDS 31.2% (T-adj) vs. 23.7% (T-fu)). For UKPDS stroke risk, a significant improvement was seen from T-adj to T-fu (19.0% (T-adj) vs. 16.4% (T-0fu): p < 0.001), with a significant deterioration noted between T-0 and T-fu (11.5% (T-0) vs. 16.4% (T-fu): P < 0.0001).

Conclusions: The Alphabet Strategy is a novel evidence-based approach to clinical diabetes care, which produced a statistically significant improvement in most of the assessed parameters. The Alphabet Practice Of Evidence-based Medicine (POEM) template is a useful clinical tool for diabetes care and audit. It includes most of the components of diabetes audit required by the National Service Framework (NSF) and the United Kingdom GP contract.

Item Type:	Journal Article
Subjects:	R Medicine
Journal or Publication Title:	CURRENT MEDICAL RESEARCH AND OPINION
Publisher:	LIBRAPHARM
ISSN:	0300-7995
Official Date:	May 2004
Dates:	Date Event May 2004 UNSPECIFIED
Volume:	20
Number:	5
Number of Pages:	8
Page Range:	pp. 765-772
Identification Number:	10.1185/03079904125003539
Publication Status:	Published
URI:	http://wrap.warwick.ac.uk/id/eprint/8404

Data sourced from Thomson Reuters' Web of Knowledge

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