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


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.



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

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