Clinical care and other categories posters: Cardiovascular

Outcomes of a multifactorial cardiovascular prevention programme in patients with type 2 diabetes: An observational study

Y Finn^1,2,3, M Gorecka⁴, G Flaherty^1,3, F Dunne^1,2,3, T O'Brien^1,2,3, J Crowley^1,3,4, D Woods^1,3, S Connolly³, J Jones^3,5, I Gibson^1,3

¹School of Medicine, National University of Ireland Galway, Galway, Ireland, ²Centre for Diabetes, Endocrinology and Metabolism, University Hospital Galway, Galway, Ireland, ³National Institute for Prevention and Cardiovascular Health, West of Ireland Cardiac & Stroke Foundation, Galway, Ireland, ⁴Department of Cardiology, University Hospital Galway, Galway, Ireland, ⁵School of Health Sciences and Social Care, Brunel University, London, UK

Aim Early multifactorial risk factor management in patients with type 2 diabetes is recommended to reduce and delay vascular complications. We conducted a prospective observational study on the effectiveness of a community-based cardiovascular disease (CVD) prevention programme on glycaemic control and cardiovascular risk factor modification in persons with newly diagnosed type 2 diabetes.

Methods Participants enrolled in a 16 weeks community-based multifactorial cardiovascular prevention programme. Glycaemia, blood pressure and lipids were measured at baseline, end of intervention and 1-year post intervention. A regression analysis was conducted to explore factors associated with improvements in glycaemic control and blood pressure.

Results One hundred and sixty-four persons (134 were men) participated with a mean age of 59.8 (10.2) years. The proportions achieving the glycaemic target (HbA1c ≤ 53mmol/mol/7%) increased from 53% at baseline to 75% (p < 0.001) at end of programme. Systolic blood pressure reduced by 8.8mm Hg (95% CI: −11.2, −6.4) and diastolic blood pressure by 5.2mm Hg (95% CI: −6.9, −3.5). Mean LDL cholesterol reduced from 2.45mmol/l to 2.05mmol/l (p < 0.001). Significantly higher proportions met recommended targets in diet (6.9% vs 43.4%, p < 0.001) and physical activity (9.2% vs 56.6%, p < 0.001). The majority of improvements were sustained at 1 year. Reductions in HbA1c were associated with higher baseline HbA1c; similarly, reductions in blood pressure were associated with higher baseline blood pressure.

Conclusion Participation in this 16-week CVD prevention programme, delivered in a community-based setting, led to improvements in glycaemic control and CVD risk factors in newly diagnosed patients with type 2 diabetes.

South Asian patients with type 2 diabetes and cardiometabolic outcomes in the United Kingdom

MN Almulhem¹, JS Chandan¹, S Hanif², T Rasiah¹, K Khunti³, A Tahrani⁴, K Niratharakumar¹, W Hanif⁵

¹Institute of Applied Health Research, University of Birmingham, Birmingham, UK, ²Department of Medicine, University College London, London, UK, ³Department of Diabetes, University of Leicester, Leicester, UK, ⁴Institute of Metabolism and System Research, University of Birmingham, Birmingham, UK, ⁵Department of Diabetes, University Hospital of Birmingham, Birmingham, UK

Introduction The South Asians (SAs) have higher incidence of diabetes and cardiovascular disease (CVD) when compared to White Europeans (WEs); however, this has not been explored in a large cohort study in the UK.

Aim To compare the incidence of CVD and mortality of SAs against WE patients with diabetes.

Method Study design: A subcohort of a large matched population-based study using THIN database. Outcomes were incidences of cardiometabolic events: hypertension, IHD, stroke, heart failure, AF and all-cause mortality.

Results A total of 19,539 patients with diabetes were identified in the dataset (11,487 SAs, 8,052 WEs). SAs had higher risk of hypertension (IRR 1.28; 95% CI: 1.11–1.49) and IHD (IRR 1.8; 95% CI: 1.54–2.11) compared WEs. However, SAs were at lower risk of AF compared to WEs (IRR 0.61; 95% CI: 0.5–0.74). There was the absence of evidence for increased risk of stroke and heart failure. Lower mortality was found in SAs with diabetes when compared to WEs with diabetes (IRR 0.80; 95% CI: 0.72–0.88).

Conclusions SA's had higher risk of IHD and hypertension when compared WE's but lower mortality. Lower mortality may be linked to lower respiratory and cancer incidence in the SAs patients with diabetes.

Assessment of patients with type 2 diabetes admitted with heart failure: Are SGLT2 inhibitors an appropriate treatment option?

J Kalloo¹, K Pham¹, Z Yousef¹, M Ahmed², A Puttanna¹

¹Acute Medicine, Good Hope Hospital, Sutton Coldfield, UK, ²Cardiology, Good Hope Hospital, Sutton Coldfield, UK

Aims Recent cardiovascular outcome trials have highlighted the benefits of SGLT2 inhibitor therapy in reducing hospitalisation for heart failure. The aim of this study was to assess whether patients hospitalised with heart failure would be appropriate candidates for SGLT2 inhibitor therapy in a real world setting.

Methods A total of 200 consecutive patients with type 2 diabetes admitted to Heart of England NHS Foundation Trust (across 3 sites) were assessed. Five patients were excluded due to lack of any clinical data. The remaining 195 patients were analysed for demographics, pre-admission Hba1c, eGFR, current medication and opportunity for SGLT2 inhibitor initiation. Further data was analysed utilising a risk stratification tool to identify those most likely to benefit from SGLT2 inhibitor therapy.

Results Mean age 75.8 years, male 126 (64.7%), female 69 (35.3%). 16 (8.2%) Afro-Caribbean, 53 (27.2%) South Asian, 122 (62.6%) White, 4 (2%) uncoded. Mean Hba1c 57.1mmol/mol (n=176), mean eGFR 45.2ml/min/1,73m² (n=194), mean length of stay 12.2 days (n=192), 56 (28.7%) patients died. For n=176, 27 (15.3%) patients met criteria for SGLT2 inhibitor use, 91 (51.7%) did not meet criteria based on eGFR, 40 (22.7%) did not meet criteria based on both Hba1c and eGFR, 18 (10.2%) did not meet criteria based on Hba1c.

Conclusions Our data reveals that only a small proportion of patients with type 2 diabetes hospitalised with heart failure meet criteria for SGLT2 inhibitor initiation. Reduced renal function was the main reason for limited SGLT2 inhibitor use. This highlights the need for earlier identification of relevant at-risk groups, potentially in a primary care or outpatient setting, in order to optimally treat these comorbidities.