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Cardiovascular Disease Prevention in Rheumatoid Arthritis: Compliance with Diabetes Screening Guidelines
Timothy J Schmidt1,2, J Antonio Aviña-Zubieta1,2, Eric C Sayre1,2
1From the Department of Medicine, and the Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; McGill University, Montreal, Quebec, Canada.
Insights
Diabetes screening compliance in rheumatoid arthritis (RA) patients was suboptimal and similar to the general population, despite higher cardiovascular disease (CVD) risks. This highlights a gap in preventive care for RA patients.
Area of Science:
- Rheumatology
- Cardiology
- Endocrinology
- Public Health
Background:
- Rheumatoid arthritis (RA) patients face increased risk of cardiovascular disease (CVD) and diabetes.
- Current guidelines recommend regular diabetes screening for CVD prevention.
- Compliance with these guidelines in RA populations is not well-established.
Purpose of the Study:
- To evaluate adherence to diabetes screening guidelines in rheumatoid arthritis (RA) patients.
- To compare diabetes screening compliance in RA versus the general population for cardiovascular disease (CVD) prevention.
Main Methods:
- A longitudinal, population-based study of RA cohort in British Columbia (1996-2010) with matched general population comparators.
- Measured compliance with plasma glucose (PG) testing every 3 years after age 45, excluding prior diabetes diagnoses.
- Used generalized estimating equation models to calculate odds ratios (OR) for compliance, adjusting for age and sex.
Main Results:
- Analysis included 22,624 RA patients and 22,579 general population controls.
- Plasma glucose (PG) testing occurred in 72.3% of eligible periods for RA and 70.4% for the general population (OR 1.05).
- RA patients met screening guidelines in 71.4% of eligible periods versus 70.6% in the general population, with screening improving over time.
Conclusions:
- Diabetes screening compliance in RA patients is suboptimal.
- There is minimal difference in screening compliance between RA patients and the general population.
- Despite higher CVD and diabetes risks, RA patients do not receive proportionally more diabetes screening.
Objective:
To evaluate compliance with diabetes screening guidelines for cardiovascular disease (CVD) prevention in rheumatoid arthritis (RA) compared to the general population.
Methods:
We conducted the first longitudinal study of a population-based RA cohort including all prevalent RA cases in British Columbia between 1996 and 2006 and followed until 2010, with matched general population comparators. Using administrative data, we measured compliance with general population guidelines [i.e., testing plasma glucose (PG) at least once every 3 years after age 45] after excluding individuals with previous diabetes. Followup was divided into 3-year eligibility periods. Compliance was measured as the proportion of periods with ≥ 1 PG test performed. OR (95% CI) of compliance in RA (vs general population) was calculated using generalized estimating equation models, adjusting for age and sex. Mean compliance rate per patient was also calculated and compared using the Mann-Whitney U test.
Results:
Analysis included 22,624 individuals with RA, contributing 48,724 three-year eligibility periods; and 22,579 people in a general population group, contributing 51,081 three-year eligibility periods. PG was measured in 72.3% (SD 37%) of the eligible time periods in the RA sample and in 70.4% (SD 38%) for the general population (OR 1.05, 95% CI 1.02-1.09, p < 0.0001). RA individuals met recommended screening guidelines in 71.4% of their eligible periods, compared to 70.6% (p < 0.001). Screening improved over time in RA relative to the general population. Family physicians ordered nearly all the PG tests.
Conclusion:
Compliance with general population guidelines for diabetes screening in RA was suboptimal, with little difference relative to the general population, despite a higher risk of CVD and diabetes.
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