Endocrine Abstracts

Current guidelines on cardiovascular (CV) disease prevention recommend targeted management after assessment of CV risks using many of available method even if the patient is asymptomatic. This study was performed to explore how CV high-risk is differently detected between two distinct methods: non-invasive test (NIT) and risk calculation and how the awareness of CV high-risk impacts physician and patient behavior for risk management in diabetes patient.

A prospective, observational study was carried out in 22 hospitals in Korea. 622 type 2 diabetes patients aged ≥40 years were assessed by carotid ultrasound (CUS) and United Kingdom Prospective Diabetes Study (UKPDS) risk engine. CV high-risk from CUS was defined as carotid intima-media thickness ≥1 mm or plaque presence. Before and 6 months after the test, patients completed a questionnaire on health-related behaviors and physicians collected data on treatment patterns via chart review.

Among 622 (mean age, 60.02±9.50 years), 271 (43.5%) and 66 (10.6%) patients were stratified as CV high-risk from CUS and UKPDS respectively. Approximately 40% of patients at moderate and low risk from UKPDS were determined as high-risk from CUS. The awareness of high-risk from CUS altered physician’s treatment patterns (P=0.021) for managing major CV risk factors: blood pressure (BP) and lipid. Along with CUS, risk levels by UKPDS also impacted physician’s behavior: more changes of treatment pattern in high than in low risk level for BP (12.0 vs 15.6%) and lipid (13.8 vs 21.6%). Patients noted increased health-related behaviors: smoking cessation and dietary changes (P<0.005 respectively) in 6-month follow-up than before CUS and bigger in high-risk.

This study identified NIT could detect more CV high-risk patients than risk calculation. However, awareness of CV high-risk itself has a positive impact on physician and patient behavior, regardless of assessment methods. Therefore, assessing CV risks using varied methods with the patient could be better for risk management in diabetes mellitus.