Effectiveness of primary care for diabetes-associated disease

Despite a number of initiatives in the United Kingdom's health system to reduce CVD morbidity and mortality, management of CVD risk factors is often suboptimal. Moreover, chronic kidney disease is either underdiagnosed or undertreated in patients with diabetes.

The EU-funded CKD-UK (Quality of chronic kidney disease management in people with diabetes in England after the introduction of new primary care policies for diabetes and renal disease) project has assessed the control of some key CVD risk factors in diabetes patients. The impact of these risk factors in terms of clinical outcomes was then examined.

Results of the cohort study on people with diabetes and statistical analysis showed that there had been a significant decline in admissions for CVD. However, people with diabetes still have up to a five-fold risk of CVD compared to people without diabetes.

As blood pressure is associated with CVD, tight control resulting in low blood pressure, below 110/75 mm Hg, is associated with poor outcomes. After statistical adjustments in a cohort of some 124 500 people for 5 years, the researchers found that flu vaccination was associated with significant reductions, up to 30 %, in hospitalisation for stroke, heart failure and pneumonia.

The CKD-UK team found that renal testing varied with gender, age and ethnicity. Overall, testing rate was higher in women, elderly patients, south Asian and Black Caribbean patients, and those with diabetes.

CKD-UK findings show that there is an ongoing need for aggressive risk reduction and primary prevention of CVD in diabetic patients. Training and educational programmes are needed to align screening for CKD with need. Policy implications as regards flu vaccines are that new vaccines and novel approaches must be devised as well as improvements in uptake of high priority groups.