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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).
Curr Med Res Opin. 2004 May; 20(5):765-72.CM

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(0)) to the most recent follow-up visit (T(fu)). The disease risk scores: a significant reduction in 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 +/- 20.5mmHg: p < 0.0001. Diastolic blood pressure improved 82.0 +/- 12.2 vs. 76.5 +/- 11.0mmHg: 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 (HbA1c)% 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 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 CHD 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(fu)): 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.

Authors+Show Affiliations

George Eliot Hospital NHS Trust, Nuneaton, UK.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15140344

Citation

Lee, J D., et al. "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, vol. 20, no. 5, 2004, pp. 765-72.
Lee JD, Morrissey JR, Patel V, et al. 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). Curr Med Res Opin. 2004;20(5):765-72.
Lee, J. D., Morrissey, J. R., & Patel, V. (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), 765-72.
Lee JD, et al. 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). Curr Med Res Opin. 2004;20(5):765-72. PubMed PMID: 15140344.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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). AU - Lee,J D, AU - Morrissey,J R, AU - Patel,V, AU - ,, PY - 2004/5/14/pubmed PY - 2004/9/17/medline PY - 2004/5/14/entrez SP - 765 EP - 72 JF - Current medical research and opinion JO - Curr Med Res Opin VL - 20 IS - 5 N2 - 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(0)) to the most recent follow-up visit (T(fu)). The disease risk scores: a significant reduction in 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 +/- 20.5mmHg: p < 0.0001. Diastolic blood pressure improved 82.0 +/- 12.2 vs. 76.5 +/- 11.0mmHg: 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 (HbA1c)% 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 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 CHD 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(fu)): 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. SN - 0300-7995 UR - https://www.unboundmedicine.com/medline/citation/15140344/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__ L2 - https://www.tandfonline.com/doi/full/10.1185/030079904125003539 DB - PRIME DP - Unbound Medicine ER -