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Observational Study
. 2022 Sep-Oct;74(5):398-405.
doi: 10.1016/j.ihj.2022.07.008. Epub 2022 Aug 2.

Association of country economy and socioeconomic factors on risk factor control for primary prevention of cardiovascular disease in patients with diabetes mellitus: Insights from the DISCOVER study

Ali O Malik  1 , Hungta Chen  2 , Fengming Tang  3 , Paul S Chan  4 , Andrew Cooper  5 , Marίlia B Gomes  6 , Vittal Hejjaji  4 , Linong Ji  7 , Kamlesh Khunti  8 , Mikhail Kosiborod  9 , Antonio Nicolucci  10 , Poghni A Peri-Okonny  4 , Marina V Shestakova  11 , Jiten Vora  12 , Hirotaka Watada  13 , Suzanne V Arnold  4
Affiliations
Observational Study

Association of country economy and socioeconomic factors on risk factor control for primary prevention of cardiovascular disease in patients with diabetes mellitus: Insights from the DISCOVER study

Ali O Malik et al. Indian Heart J. 2022 Sep-Oct.

Abstract

Background: We sought to describe global patterns in achievement of risk factor control for primary prevention in patients with T2D and explore the association of country's GNI/capita with risk factor control.

Methods: The DISCOVER study is a prospective, observational study of patients with T2D from 38 countries enrolled at initiation of second-line glucose-lowering therapy. We examined achievement of risk factor control (glycosylated hemoglobin <7%, blood pressure <140/90 mmHg, prescription of a statin) at 3 years among those without optimal control at baseline. Countries were stratified by gross national income (GNI)/capita, from 2017). We examined the impact of country GNI/capita with achievement of risk factor control.

Findings: Our cohort included 9613 patients with T2D and without baseline cardiovascular disease (mean age 57.2 ± 8.7 years, 47.9% women). At baseline, 6354/7646 patients (83.1%) had suboptimal glucose control, 3449/9200 patients (37.5%) had suboptimal BP control, and 2800/4221 patients (66.7%) were not on an appropriate statin (sample sizes differed due to missing covariate data). Optimal control at 3 years of follow-up was achieved in 41% (glucose), 56% (blood pressure), and 29% (statins) of patients. There was significant variability in achievement of risk factor control across countries but no association between country GNI/capita with achievement of risk factor control (p > 0.08 for all).

Interpretation: In a global, prospective study of patients with T2D, we found that cardiovascular risk factor control achievement was suboptimal despite 3 years of follow-up in specialized health care systems. Neither country-level nor patient-level socioeconomic factors fully explained this finding.

Keywords: Primary prevention; Risk factor control; Type 2 diabetes.

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Figures

Image 1
Graphical abstract
Fig. 1
Fig. 1
Derivation of analytical cohort.
Fig. 2
Fig. 2
Country level variability for risk factors control at 3 years. A. glucose; B. blood pressure; C. appropriate statin. For statins, Costa Rica, Denmark, Japan, Oman, and Bahrain were excluded, as <10 patients could be assessed.
Fig. 3
Fig. 3
Association of patient factors with achievement of risk factor control at 3 years.
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