{"id":4371,"date":"2015-05-16T00:00:00","date_gmt":"2015-05-16T04:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/early-specialist-care-for-diabetes-who-benefits-most-a-propensity-score-matched-cohort-study\/"},"modified":"2023-06-14T20:11:36","modified_gmt":"2023-06-15T00:11:36","slug":"early-specialist-care-for-diabetes-who-benefits-most-a-propensity-score-matched-cohort-study","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/early-specialist-care-for-diabetes-who-benefits-most-a-propensity-score-matched-cohort-study\/","title":{"rendered":"Early specialist care for diabetes: who benefits most? A propensity score-matched cohort study"},"content":{"rendered":"<p><strong>Aims <\/strong>&#x2014; To examine whether early endocrinologist care reduces the risk of cardiovascular complications among newly diagnosed patients with diabetes of differing complexity.<\/p>\n<p><strong>Methods<\/strong> &#x2014; We conducted a population-based propensity-score matched cohort study using provincial health data from Ontario, Canada. Adults (&#x2265;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 (<em>N<\/em>=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.<\/p>\n<p><strong>Results<\/strong> &#x2014; 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&#x2013;1.01) and major cardiovascular events or all-cause death (hazard ratio 0.91, 95% CI 0.85&#x2013;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 &#x2265;3 visits to an endocrinologist (primary endpoint: hazard ratio 0.69, 95% CI 0.56&#x2013;0.86 and 0.61, 95% CI 0.45&#x2013;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.<\/p>\n<p><strong>Conclusions<\/strong> &#x2014; 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.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Aims &#x2014; To examine whether early endocrinologist care reduces the risk of cardiovascular complications among newly diagnosed patients with diabetes of differing complexity. Methods &#x2014; We conducted a population-based propensity-score matched cohort study using provincial health data from Ontario, Canada. Adults (&#x2265;30 years) diagnosed with diabetes between 1 April 1998 and 31 March 2006 who [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[40,50,62],"migration-helper-qa-sample-set":[],"class_list":["post-4371","journal_article","type-journal_article","status-publish","hentry","topic-cardiovascular-disease","topic-endocrinology","topic-health-services-research"],"acf":{"citation":"Booth GL, Shah BR, Austin PC, Hux JE, Luo J, Lok CE. <em>Diabet Med<\/em>. 2016; 33(1):111-8. Epub 2015 May 16.","source_url":"","ices_scientist":[1175,1361,1385,1268],"site":[6733],"research_program":[6746,6742],"news_release":[7825],"journal_article":[],"atlas":[],"research_report":[],"infographic":[],"video":[],"downloads":null,"links":null,"sitecore_item_id":"B431BEB1-7F76-4D63-AE3E-F2E983345E1B","sitecore_item_name":"Early-specialist-care-for-diabetes-who-benefits-most-a-propensity-score-matched-cohort-study","sitecore_field_values":"{\n  \"Title\": \"Early specialist care for diabetes: who benefits most? A propensity score-matched cohort study\",\n  \"Short title\": \"Early specialist care for diabetes\",\n  \"Summary\": \"The aim of this study was to examine whether early endocrinologist care reduces the risk of cardiovascular complications among newly diagnosed patients with diabetes of differing complexity.\",\n  \"Citation\": \"<p>Booth GL, Shah BR, Austin PC, Hux JE, Luo J, Lok CE. <em>Diabet Med<\/em>. 2016; 33(1):111-8. Epub 2015 May 16.<\/p>\",\n  \"Abstract\": \"<p><strong>Aims <\/strong>&mdash; To examine whether early endocrinologist care reduces the risk of cardiovascular complications among newly diagnosed patients with diabetes of differing complexity.<\/p>rn<p><strong>Methods<\/strong> &mdash; We conducted a population-based propensity-score matched cohort study using provincial health data from Ontario, Canada. Adults (&ge;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 (<em>N<\/em>=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.<\/p>rn<p><strong>Results<\/strong> &mdash; 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&ndash;1.01) and major cardiovascular events or all-cause death (hazard ratio 0.91, 95% CI 0.85&ndash;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 &ge;3 visits to an endocrinologist (primary endpoint: hazard ratio 0.69, 95% CI 0.56&ndash;0.86 and 0.61, 95% CI 0.45&ndash;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.<\/p>rn<p><strong>Conclusions<\/strong> &mdash; 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.<\/p>\",\n  \"Keywords\": \"{26EB1DB1-6793-4CB3-9CFB-DFF37E09FB5A}|{834CBA58-C3B8-4F52-A847-40C23503994D}|{92E2791D-5DAB-4244-8A85-434D524D9A12}|{80AF17F9-2AF8-43F7-9CA1-8A45542CDF7C}\",\n  \"Related Products\": \"<h2>News Release<\/h2>rn<h3><a href=\"~\/link.aspx?_id=4CC5F3C36DCC41A790D68D896B531DA9&amp;_z=z\">Medically complex patients with Type 2 diabetes have less heart disease, lower death rates if they see a specialist soon after diagnosis; healthier patients do well with family doctors<\/a><\/h3>rn<h2>ICES IN THE NEWS<\/h2>rn<h3><a href=\"http:\/\/www.healthcanal.com\/metabolic-problems\/diabetes\/64854-medically-complex-patients-with-type-2-diabetes-have-less-heart-disease-lower-death-rates-if-they-see-a-specialist-soon-after-diagnosis-healthier-patients-do-well-with-family-doctors.html\" title=\"External link to HealthCanal website opens in new window\" target=\"_blank\">Medically complex patients with Type 2 diabetes have less heart disease, lower death rates if they see a specialist soon after diagnosis; healthier patients do well with family doctors<\/a><\/h3>\",\n  \"Research Programs\": \"{CFE36C89-C969-4C23-B5E4-1BA9E5BDC273}|{BEC72DE0-BA8C-42B8-ACE5-EE29FFB2CB3B}\",\n  \"ICES Locations\": \"{4FCAABBA-14A5-42E6-8F33-BC6C2F1D9908}\",\n  \"ICES Scientists\": \"{98B8617F-C6B9-4032-9C0D-7053D3651ABA}|{4CA3655C-D15C-43EC-8F5D-9FE401C24F27}|{7D498E8B-5801-4F9E-AC41-11ED50F3C34E}|{4C08D086-0DAC-4164-B8DF-54317B959A2C}\",\n  \"Posted Date\": \"20150516T000000\",\n  \"Show on Publications Landing Page\": \"1\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2015\/January\/Early-specialist-care-for-diabetes-who-benefits-most-a-propensity-score-matched-cohort-study"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Early specialist care for diabetes: who benefits most? 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