App quickly measures cardiovascular risk in patients with diabetes

Researchers published the to learn treated in this summary on Research Square as a preprint that has not yet been peer-reviewed.

The central theses

• Researchers in Italy have developed a web-based app called AWARE that allows clinicians to quickly rate the cardiovascular (CV) risk of patients with type 2 diabetes as moderate, high, or very high using 2019 European Society of Cardiology (ESC) criteria be able. /Guidelines of the European Association for the Study of Diabetes (EASD) on diabetes, prediabetes and cardiovascular diseases (CVD).

• In a proof of concept study with more than 2,000 patients examined in diabetes clinics, doctors entered patient data into the app, which took about 20 seconds. Based on the data, the app rated the cardiovascular risk in the cohort as very high (72.2% of patients), high (9.9%), or moderate (0.8%). However, 18.2% of patients did not fall into any of the risk categories and were classified as moderate to high cardiovascular risk.

• The mean A1c of the overall population was 7.5%, and the A1c was above the recommended 7% in each of the four cardiovascular risk groups.

• Only about 25% of patients at high or very high cardiovascular risk were prescribed a sodium-glucose cotransporter-2 (SGLT2) inhibitor or a glucagon-like peptide-1 (GLP1) agonist, according to the 2019 ESC/EASD guidelines first recommend -line treatment for such patients.

Why this matters

• In a busy clinic, where patients with type 2 diabetes are typically treated during a 15-minute visit, it may not be practical to assess each patient’s cardiovascular risk using the criteria of the 2019 ESC/EASD guidelines.

• However, failing to determine the cardiovascular risk of a patient with type 2 diabetes would miss some high or very high risk patients who would benefit from early initiation of an SGLT2 inhibitor or GLP-1 agonist, delaying organ damage or could prevent (of the heart, kidney and eyes).

• This first feasibility study of a web app to stratify cardiovascular risk in patients with type 2 diabetes showed that clinicians could use the app in clinical practice to quickly and efficiently assess this risk.

• The free and online available AWARE app (UserID: Aware; Password: Aware) has the potential to increase physicians’ awareness of the cardiovascular risk of a particular type 2 diabetes patient and potentially help them determine a implement more aggressive and earlier treatment with newer drugs that could help prevent chronic serious complications and premature death.

study design

• The AWARE app, which can be downloaded to a computer, smartphone or tablet, regardless of the operating system, was developed by the Italian company SoftwareVM on behalf of the diabetes centers involved in the study to assess cardiovascular risk in patients with type 2 diabetes to be evaluated Criteria of the ESC/EASD Guideline 2019.

• The app consists of a short form lasting about 20 seconds with the following patient information:

  • Age (< 50 or ≥ 50 years old)

  • Diabetes duration (< 10 or ≥ 10 years)

  • Presence of an established CVD (yes or no)

  • Target organ damage, yes or no for each of the following: proteinuria, chronic kidney disease (eGFR < 30 mL/min/1.73 m²), retinopathy or left ventricular hypertrophy

  • Important cardiovascular risk factors, yes or no for each of the following four factors: smoking, dyslipidemia, hypertension, obesity and the patient’s age.

• Type 2 diabetes patients were classified as follows:

  • Very high risk: Established cardiovascular or other target organ damage or three or more major cardiovascular risk factors

  • High risk: Diabetes for ≥ 10 years without target organ damage plus an additional major risk factor

  • Intermediate risk: Young (< 50 years) with diabetes duration < 10 years, without other risk factors

  • Moderate to very high risk: Patients who do not fall into any of the other three categories.

• In the current study, the form also had a place to record the patient’s A1c and diabetes medication (metformin, basal insulin, rapid insulin, sulfonylurea, pioglitazone, repaglinide, acarbose, dipeptidyl peptidase 4 (DPP4) inhibitor, SGLT2 inhibitor, GLP1 -agonist) to detect, or no current therapy).

• The app was used to calculate cardiovascular risk and determine A1c and current pharmacological treatment of 2243 consecutive patients with type 2 diabetes who attended diabetology centers in Lombardy from November 2020 to April 2021.

Key Results

• Patients with a very high cardiovascular risk were more often ≥ 65 years old (68.9%). More than half had diabetes for ≥10 years (56.8%). Many had a history of cardiovascular disease (41.4%) or organ damage (35.5%). They also had a higher number of cardiovascular risk factors than patients in other risk groups.

• In general, patients with intermediate to high cardiovascular risk had diabetes for less than 10 years (96%) and were younger (55% were 50-60 years old), had no history of cardiovascular disease and organ damage, and had one to two cardiovascular risk factors (89%).

• GLP-1 agonists or SGLT2 inhibitors were prescribed to only 26.3% of patients at very high CV risk and 24.7% of patients at high CV risk.

limitations

disclosure

This is an abstract of a preprint research study “ DELIBERATELY. A web application for rapid cardiovascular risk assessment in type 2 diabetes mellitus, “ written by researchers mainly from the University of Milan, Lombardy, Italy. Research Square preprints are provided by Medscape. This study has not yet been peer-reviewed. The full text of the study can be found on Research Square.

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