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Early specialist care for diabetes: who benefits most? A propensity score-matched cohort study

Booth GL, Shah BR, Austin PC, Hux JE, Luo J, Lok CE. Diabet Med. 2016; 33(1):111-8. Epub 2015 May 16.

Aims — To examine whether early endocrinologist care reduces the risk of cardiovascular complications among newly diagnosed patients with diabetes of differing complexity.

Methods — We conducted a population-based propensity-score matched cohort study using provincial health data from Ontario, Canada. Adults (≥30 years) diagnosed with diabetes between 1 April 1998 and 31 March 2006 who received endocrinologist care in the first year of diagnosis were matched to a comparison group receiving primary care alone (N=79 020) based on propensity scores and medical complexity (assigned using information on chronic conditions). Individuals were followed for 3- and 5-year outcomes, including non-fatal acute myocardial infarction or coronary heart disease death (primary endpoint), major cardiovascular events (acute myocardial infarction, stroke) or all-cause death, amputation and end-stage renal disease.

Results — Among medically complex patients, early endocrinologist care was associated with a lower 3-year incidence of the primary endpoint (hazard ratio 0.89, 95% CI 0.78–1.01) and major cardiovascular events or all-cause death (hazard ratio 0.91, 95% CI 0.85–0.97). These effects persisted after accounting for a higher incidence of end-stage renal disease on follow-up and were greatest in those with ≥3 visits to an endocrinologist (primary endpoint: hazard ratio 0.69, 95% CI 0.56–0.86 and 0.61, 95% CI 0.45–0.82, for unadjusted and end-stage renal disease adjusted analyses, respectively). In contrast, no benefit was observed in the non-medically complex subgroup. Overall effects were similar at 5 years.

Conclusions — Early endocrinologist care is associated with a lower incidence of cardiovascular events and death among newly diagnosed patients with diabetes who have comorbid medical conditions.

Keywords: Diabetes Endocrine and metabolic disorders Cardiovascular diseases Health care services