Cardiovascular risk factors in type 2 diabetic outpatient according to the recommendations of esc-easd 2019

Nội dung text: Cardiovascular risk factors in type 2 diabetic outpatient according to the recommendations of esc-easd 2019

1. Journal of Diabetes & Endocrinology No. 48 - 2021 CARDIOVASCULAR RISK FACTORS IN TYPE 2 DIABETIC OUTPATIENT ACCORDING TO THE RECOMMENDATIONS OF ESC-EASD 2019 Huynh Le Thai Bao1,* 1. Faculty of Medicine, Duy Tan University, Da Nang, Vietnam DOI: 10.47122/vjde.2021.48.3 ABSTRACT 1. STATEMENT OF THE PROBLEM Cardiovascular risk factors in type 2 diabetic In recent years, cardiovascular disease has outpatient according to the recommendations always been the leading cause of death in the of ESC-EASD 2019 world. According to the World Health Organization (WHO) in 2016, every year about Objectives: To evaluate some cardiovascular 17.9 million people die from cardiovascular risk factors in type 2 diabetes outpatient disease, accounting for 31% of all deaths receiving treatment at Cu Jut district general worldwide [6]. In Vietnam, according to WHO, hospital, Dak Nong province in 2020 according the death rate from cardiovascular disease is to the recommendations of ESC-EASD 2019. also 31% [7] -. Therefore, the prevention of Methodology: The study used a descriptive cardiovascular diseases helps to reduce the cross-sectional design with a continuous burden of disease on society. For effective sampling method during the study to evaluate prevention, it is essential to control the risk some cardiovascular risk factors in patients factors. with type 2 diabetes mellitus treatment. reside Of the above cardiovascular risk factors, at the medical center of Cu Jut district, Dak diabetes is an important and independent risk Nong in 2020 according to the recommended factor. The prevalence of diabetes in the world treatment recommendations of ESC-EASD is on the rise, with an estimated 60 million 2019. Each patient in the study sample was Europeans infected [9]. In East Asian countries, examined and given the contents of the with lifestyles gradually becoming more similar prepared questionnaire. Each was designated to the West, the prevalence of diabetes any required subclinical processes as necessary. continues to increase, up to 10% of the Results obtained: Target characteristics of population as in China, India [9]. In Vietnam, controlling some cardiovascular risk factors in up to 5.42% of people aged 30-69 years have diabetic patients according to ESC - EASD diabetes. These figures pose a serious challenge 2019 guidelines: BMI ratio over 23 kg / m2 is for developing economies, as the 35.3%, round rate increase abdomen was cardiovascular complications of diabetes can 76.05%, incidence of uncontrolled blood cause premature death, disability, loss of work pressure was 47.3%, total cholesterol was capacity, and socio-economic consequences. 49.3%, tryglicerid was 50.7%, HDL-C was [1]. 34.7% and non-HDL-C was 54.6% and LDL-C In 2019, ESC and EASD jointly launched was 82.8%. the " Guidelines on Diabetes, Pre-Diabetes and Keywords: Type 2 diabetes, ESC - EASD Cardiovascular Diseases" to provide guidance 2019, cardiovascular risk stratification, on the management and prevention of cardiovascular disease, target organ damage. cardiovascular disease in those already suffering from disease or at risk of diabetes. Main correspondence: Huynh Le Thai Bao These guidelines emphasize the development of Submission date: 20th April 2021 ways to prevent and manage the impact of Revised day: 26th April 2021 diabetes on cardiovascular disease. The guide Acceptance date: 26th May 2021 also uses ESC 2016 cardiovascular risk Email: hlthaibao@gmail.com stratification and includes new updates on Tel: 0888838539 individualization of cardiovascular risk factors 14
2. Journal of Diabetes & Endocrinology No. 48 - 2021 treatment. - Blood sugar is usually stable even with From the above reasons, we conducted this lifestyle changes or non-insulin medications; study to evaluate some cardiovascular risk - Excluding type 1 diabetes and other special factors in patients with type 2 diabetes in type outpatient treatment at Cu Jut district health • Exclusion criteria: center, Dak Nong by 2020 according to - The patient does not agree to participate in Treatment recommendation goals of the ESC- the study. EASD 2019. - Patients with acute complications of diabetes. 2. SUBJECT AND METHODOLOGY Research Methods Research location and time: Department of Study design: Descriptive cross-sectional Examination and Emergency, Medical Center study. of Cu Jut district, Dak Nong province from Sampling: Survey the entire target January 2020 to June 2020. population through consecutive sampling Subjects: All patients with confirmed during the study period. diagnosis of type 2 diabetes who came for Standards used in research examination and follow-up examinations. Meet • Identified cardiovascular disease: A the following criteria: cardiovascular disease that has been clinically • Sampling criteria or clearly identified, including: history of Patients diagnosed with diabetes by myocardial infarction, acute coronary fasting glucose according to the standards of syndrome, coronary revascularization, cerebral the American Diabetes Association in 2017 stroke and peripheral artery disease. [10]: • ESC 2016 stratification of cardiovascular -When there are clinical symptoms of risk factors for diabetic patients [12]: diabetes (heavy drinking, excessive urination, Very high risk: Diabetic patients already weight loss) or acute decompensation with ≥ 1 suffering cardiovascular disease test: + Or other target organ damage (Proteinuria, + Fasting glucose: ≥ 7.0 mmol / l. renal failure when eGFR <30mL /min, left + HbA1 C ≥ 6.5%. ventricular hypertrophy, retinopathy) Any blood sugar ≥ 11.1mmol / l. + Or ≥ 3 main risk factors (age greater than -When there are no clinical symptoms of 65, hypertension, dyslipidemia, smoking, diabetes and acute decompensation, based on obesity) tests: + Or early onset diabetes with long duration + Fasting glucose: ≥ 7.0 mmol / l, ≥ 2 times (> 20 years) at least 1 day apart. High risk: Diabetes duration ≥ 10 years, no + HbA1 C ≥ 6.5%, ≥ 2 times at least 3 target organ damage + no other additional risk months apart. factors. + Fasting glucose ≥ 7.0 mmol / l and HbA1 Average risk: Young (<50 years) patient C ≥ 6.5%. with diabetes duration <10 years, with no other Previous diagnosis of diabetes risk factors. - Previously diagnosed with diabetes, • The recommended treatment goals currently taking diabetes medicine with any according to ESC Guidelines - EASD 2019 for amount of blood sugar. diabetic patients [9]: - Previously diagnosed with diabetes, The ESC - EASD 2019 guidelines have dropped out of treatment and only meet many updates compared to the ESC - EASD requirements of fasting glucose or high HbA1C. 2016, in which the treatment recommendation Diagnosis of type 2 diabetes goals are individualized: Onset is usually discreet; - Target blood pressure: For patients ≤ 65 15
3. Journal of Diabetes & Endocrinology No. 48 - 2021 years old: The target systolic blood pressure is standard deviation (Mean ± SD) or median and 130 mmHg, if tolerated it can be reduced to the minimum and maximum value when distributing the deviation. Qualitative data are 65 years of age, the target systolic blood presented as a percentage. pressure is between 130 mmHg and 139 mmHg. The target for diastolic blood pressure is <80 3. FINDINGS AND DISCUSSION mmHg but not <70 mmHg. General characteristics of the research Target blood fat: For average cardiovascular sample risk, target LDL-C <2.5mmol / L, for high During the implementation period, there cardiovascular risk, LDL-C <1.8 mmol / L, for were 150 subjects participating in our study. heart risk very high circuit, LDL-C <1.4 mmol The average age of the study sample is 60.06 / L. Other lipid indexes: Total cholesterol (TC) ± 10.88. The age group with the highest <4.5 mmol / L, Triglycerid <2.3 mmol / L, proportion is the age group 50-59 with 31.3% HDL-C> 1.0 mmol / L, non HDL - C <3.3 mmol and the age group 60-69 with 30.0%. / L. This result is similar to many studies. In the - Target blood sugar: fasting glucose <7.2 study of Nguyen Le Phuong Anh (2019) at the mmol / L, postprandial glucose <10 mmol / L, District 3 Hospital - Ho Chi Minh City, the two HbA1C <7%. age groups accounting for the highest - Smoking: Stop required. proportion are 60-69 years old with 34.9% and - Exercise strength: 30 - 45 minutes / day 50-59 years old with 27% [2]. - BMI: less than 23 kg / m2 In the study of Vien Van Doan (2012) at - Waist circumference: <90 cm for men and Bach Mai hospital, the age group accounting for <80 cm for women. the highest percentage is 50-60 years old with Data processing and analysis: Data entry 41.2%, followed by the 60-70 years old group using EpiData 3.1 software, data processing with 33.8%. It can be seen that the age group 50 using R Studio 4.0 software. Values of - 70 years old always accounts for the highest quantitative variables are presented as mean ± proportion in the studies [5]. 35 30 25 20 NamMale 15 NữFemale 10 5 0 70 Chart 1. General characteristics of research sample In our study, women account for 59.3% higher than men with 40.7%. This rate is similar to the study of Vien Van Doan (2012) with 59.8% female, 40.2% male and Nguyen Le Phuong Anh (2019) with 53% of females and 53% of men. accounting for 47% [2], [5]. Among the studies, the percentage of women is always higher than that of men. 16
4. Journal of Diabetes & Endocrinology No. 48 - 2021 35% 30% 25% 20% 15% 10% 5% 0% CardiovascularBệnh tim mạch diseases KidneySuy thậnfailure ProteinProteinuria niệu Chart 2. Characteristics of cardiovascular disease and other target organ damage of study sample In our study, the rate of cardiovascular disease is 30%, the rate of kidney failure is 21.3% and the rate of proteinuria is 22.7%. Our results are much higher than the study of Vien Van Doan (2012) with the rate of myocardial infarction of 1.8%, renal failure 2.8%, proteinuria 9.8% [5]. However, our research is consistent with some literature around the world, according to Joshua A. Beckman et al., The incidence of cardiovascular disease in diabetic patients is 20%, according to ADA 2016, the rate of failure kidney in patients with diabetes is from 20-40% [8]. 60% 49% 50% 47% 40% 30% 20% 10% 4% 0% NguyVery cơ high rất riskcao Nguy cơ cao Nguy cơ trung bình Very high risk High risk Average risk Chart 3. Stratification of cardiovascular risk factors among the research subjects In our study, the very high risk group had has just been diagnosed with type 2 diabetes. the highest proportion at 49%, followed by This raises the issue of early screening for the medium risk group with 47% and the type 2 diabetes in the community for early lowest with the high risk group with 4%. In treatment strategies and prevention of our opinion, the very high risk group accounts cardiovascular risk factors. for a large proportion because the majority of The average risk group also accounts for a patients after discovering cardiovascular relatively high proportion because the time to disease (stroke, myocardial infarction ...) or detect diabetes in the study sample is quite damage to the target organ (kidney failure ...) low, 95.3% is less than 10 years. 17
5. Journal of Diabetes & Endocrinology No. 48 - 2021 Table 1. Characteristics of several traditional cardiovascular risk factors in study sample Factor Grouping Frequency Ratio % Average ± Standard deviation > 60 years 75 50,0% 60,06 ± 10,88 Age ≤ 60 years 75 50,0% (Years) ≥ 10 years 7 4,7% 4,3 ± 3,0 (Years) History of diabetes < 10 years 143 95,3% Yes 32 21,3% Smoking No 118 78,7% Yes 49 32,7% Physical activity Sedentary 101 67,3% Associations of cardiovascular, Truc Linh (2016) with 78.4% [4]. The hypertension and diabetes have long placed proportion of people having been diagnosed advanced age, duration of diabetes, smoking with diabetes for less than 10 years in our study and physical activity into the group of is higher probably due to the poor awareness of cardiovascular risk factors. In our study, the rate screening, a not small part of detecting diabetes of patients aged 60 and over is 50.0%, this result after being hospitalized for target organ is relatively consistent with some other studies damage. The rate of smoking and less physical such as by Tran Thi Truc Linh (2016) with the activity in our study was 21.3% and 67.3%, this rate of 60 years and over. to 68.1% [4] and Ina result is similar to many other studies such as Maria Ruckert (2012) with this rate is 54.32% Tran Thi Truc Linh (2016) when two billion [13]. Up to 95.3% of patients have been This rate is 10.3% and 28.4 [4], the study of diagnosed with diabetes for less than 10 years, Leiter.Lawrence A (2013) smoking rate is this rate is higher than the study of Tran Thi 36.1% [11]. Table 2. Characteristics related to controlling BMI, waste circumference, arterial blood pressure according to ESC - EASD 2019 Average ± Unsatisfactory Satisfactory Standard Target deviation Frequency Ratio % Frequency Ratio % BMI < 23 kg/m2 53 35,3% 97 64,7% 23,99 ± 1,44 Waste circumference < 114 76,05% 36 24,0% 87,13 ±5,44 90 cm (Male) < 80 cm (Female) Blood pressure * 71 47,3% 79 52,7% Systole blood pressure 143,88 ± 8,37(mmHg) Diastolic blood pressure 81,21 ± 12,73 (mmHg) (* Individualization standards are outlined in circumference was 76.05%. This result is similar the section "Standards used in research") to the study of Tran Thi An Nhan (2019) with a In our study, the rate of BMI over 23 kg / m2 BMI of over 23 kg / m2 of 28.9% [3], the study of was 35.3% and the rate of increase in waist Tran Thi Truc Linh (2016) with a BMI of over 23 18
6. Journal of Diabetes & Endocrinology No. 48 - 2021 kg / m2 is 27.6% and the rate of increase in 2019 is 47.3%, lower than that of Tran Thi Truc abdominal circumference is 64.7% [4]. It can be Linh (2016) with this rate of 59, 5% [4], this seen that abdominal fat has a much higher rate difference is due to the sample characteristics of than being overweight, and we think a larger study the study above that patients with both type 2 is needed to find a link between increased waist diabetes and hypertension, and this study used a circumference and type 2 diabetes. goal of controlling blood pressure according to the In our study, the rate of uncontrolled blood ESC - EASD 2013. pressure according to the goals of ESC - EASD Table 3. Features of blood lipid control according to ESC - EASD 2019 Average ± Standard Factor (Unit) Unsatisfactory Satisfactory deviation (mmol/L) TC < 4,5 mmol/L 74 49,3% 76 50,7% 4,57 ± 1,47 TG < 2,3 mmol/L 76 50,7% 74 49,3% 2,55 ± 1,57 HDL-C ≥ 1 mml/L 52 34,7% 98 65,3% 1,1 ± 0,30 Non HDL-C < 3,3 mmol/L 82 54,6% 68 55,4% 3,95 ± 1,33 LDL-C ** 124 82,7% 26 17,3% 3,05 ± 1,12 (** Individualization standards are listed non HDL-C 71.6% [2], [4]. As for LDL-C, under "Standards used in research") after applying the individualized treatment In our study, the rates of failure to meet the goal according to cardiovascular risk blood lipid control targets in diabetic patients stratification, the failure rate was quite high at according to ESC - EASD 2019 were: Total 82.7%. This result is much higher than the cholesterol 49.3%, Tryglicerid 50.7%, HDL-C study of Nguyen Le Phuong Anh (2019) with 34, 7% and non HDL-C 54.6%. This result is 46.0% and Tran Thi Truc Linh (2016) with quite similar to the study of Nguyen Le 79.3% [2], [4]. This increase is because ESC - Phuong Anh (2019) with total cholesterol EASD 2019's target of treatment 52.1%, Tryglicerid 43.3% and Tran Thi Truc recommendation in LDL-C control is more Linh's study (2016) with total cholesterol "rigorous" than ESC - EASD 2013, so the rate 60.3%, Tryglicerid 40.5%, HDL-C 35.3% and of LDL-C failure in our study quite tall. Table 4. Features of blood glucose control according to ESC - EASD 2019 Average ± Standard Factor (Unit) Unsatisfactory Satisfactory deviation (mmol/L) Fasting glucose <7.2 mmol / L 95 60,3% 55 36,7% 10,68 ± 4,91 Postprandial Glucose <10 98 65,3% 52 34,7% 13,45 ± 4,24 mmol / L HbA1C <7% 91 60,7% 55 36,7% 8,16 ± 1,95 All 3 blood glucose targets 118 78,7% 32 21,3% In our study, the group of patients did not Truc Linh (2016) with the rate of not meeting reach the target of fasting glucose of 60.3%, the blood glucose targets are: fasting glucose postprandial glucose was 65.3%, HbA1c60.7%. 74.1%, postprandial glucose 77, 6%, HbA1c The control group did not meet all three blood is 66.4%, all three target 90.5% blood glucose glucose targets with a relatively high rate of [4]. In our opinion, this is because our research 78.7%. team has a rather high rate of target organ The control of blood sugar in our study is damage, so patient compliance is somewhat somewhat better than the study of Tran Thi more positive. 19
7. Journal of Diabetes & Endocrinology No. 48 - 2021 4. CONCLUSION factors in type 2 diabetic patients at Central In our study: Highlands General Hospital in 2019. 1. Characteristics of cardiovascular disease Grassroots-level scientific topic: and target organ damage: cardiovascular University of the Central Highlands. disease rate is 30%, kidney failure rate is 21.3% 4. Tran Thi Truc Linh. (2016). Study on the and proteinuria rate is 22.7%. relationship between cardiac 2. Stratification characteristics of manifestations and targets according to cardiovascular risk factors: the very high risk ESC - EASD recommendation in group accounts for the highest proportion with hypertensive type 2 diabetic patients. 49%, followed by the medium risk group with Doctor of Medicine thesis: University of 47% and the lowest is the high risk group with Medicine - Hue University. 4% 5. Vien Van Doan. (2012). Control Outcomes 3. Characteristics of some traditional Some cardiovascular risk factors in cardiovascular risk factors: 50.0% of patients diabetic patients that are managed and aged 60 years and older, 95.3% of patients with treated outpatiently at the Clinical diabetes under 10 years, rate of smoking The Department, Bach Mai Hospital. . Bach leaves and less physical activity in our study Mai Hospital. were 21.3% and 67.3%. 6. WHO. (2020). Viet Namstatistics summary 4. The target characteristics of controlling (2002 - present). Global Health some cardiovascular risk factors in diabetic Observatory country views. patients according to the guidance of ESC - 7. Institute for Health Metrics and Evaluation EASD 2019: BMI rate above 23 kg / m2 is (2017).Global Burden of Disease Study 35.3%, the rate of increase in abdominal 2017. Global health data circumference 76.05%, the rate of uncontrolled 8. Beckman, J. A., Creager, M. A. & Libby, P. blood pressure was 47.3%. (2002). Diabetes and atherosclerosis: 5. Characteristics of blood lipid control in epidemiology, pathophysiology, and diabetic patients as guided by ESC - EASD management. JAMA, 287(19), 2570-2581. 2019: Total cholesterol 49.3%, Tryglicerid 9. Cosentino, F., Grant, P. J., Aboyans, V., 50.7%, HDL-C 34.7% and non HDL-C 54 , 6% Bailey, C. J., Ceriello, A., Delgado, V., et and LDL-C is 82.7%. al. (2020). 2019 ESC Guidelines on 6. Glucose control characteristics according diabetes, pre-diabetes, and to ESC - EASD 2019 guidelines: the percentage cardiovascular diseases developed in of patients who failed to reach the target of collaboration with the EASD. Eur Heart fasting glucose was 60.3%, after eating glucose J, 41(2), 255-323. was 65.3%, HbA1c60.7%. 10. Goyal, A., Gupta, Y., Singla, R., Kalra, S. & Tandon, N. (2020). American Diabetes REFERENCES Association "Standards of Medical Care- 1. Nguyen Hai Thuy, L. V. C. (2018). 2020 for Gestational Diabetes Mellitus": A Diabetes, University Curriculum, Internal Critical Appraisal. Diabetes Ther. Medicine. Hue University Publishing 11. Halperin, I. J., Ivers, N. M. & Wong, R. House: Thua Thien Hue. (2013). Re: Leiter LA, Berard L, Bowering 2. Nguyen Le Phuong Anh. (2019). Survey on CK, et al. Type 2 Diabetes mellitus the situation of dyslipidemia in patients management in Canada: is it improving? with type 2 diabetes at Hospital District 3 - Can J Diabetes 37;2:82-9. Can J Diabetes, HCMC Graduation thesis, Van Lang 37(4), 213. University. 12. Piepoli, M. F., Hoes, A. W., Agewall, S., 3. Tran Thi An Nhan. (2019). Ankle-arm Albus, C., Brotons, C., Catapano, A. L., et blood pressure index and some related al. (2016). 2016 European Guidelines on 20
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