Cardiologists vs Endocrinologists in Glycemic Control for Coronary Artery Disease Patients with Type 2 Diabetes: A
Qin Xia1, Qianwen Peng1, Hefeng Chen1
1Department of Pharmacy, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
Insights
Endocrinologists actively intensify glycemic control in patients with coronary artery disease and type 2 diabetes mellitus, while cardiologists often refer patients for specialized care. Integrated approaches are needed for better cardiovascular risk management.
Area of Science:
- Cardiology
- Endocrinology
- Metabolic Diseases
Background:
- Coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) commonly coexist, complicating patient management.
- Poor glycemic control in T2DM exacerbates cardiovascular risks, increasing morbidity and mortality.
- Cardiologists are increasingly involved in diabetes management due to the significant cardiovascular implications.
Purpose of the Study:
- To investigate current glycemic management practices by cardiologists and endocrinologists in Chinese patients with CAD and T2DM.
- To compare treatment intensification strategies between the two specialties.
- To assess the achievement of comprehensive cardiovascular risk management targets.
Main Methods:
- A cross-sectional study of 1,074 hospitalized patients with CAD and T2DM.
- Retrospective data collection from electronic medical records (January 2021 - December 2023).
- Analysis of glycemic control (HbA1c) and treatment intensification, stratified by physician specialty.
Main Results:
- Endocrinologists were more likely to intensify antidiabetic therapy, particularly for severe hyperglycemia (HbA1c ≥9.0%).
- Cardiologists demonstrated limited in-hospital glycemic management, favoring outpatient referrals.
- Despite improvements, few patients met comprehensive cardiovascular risk management targets.
Conclusions:
- Endocrinologists play a more active role in glycemic treatment intensification for patients with CAD and T2DM.
- Distinct yet complementary roles exist between cardiologists and endocrinologists.
- Integrated care models are essential to optimize outcomes and cardiovascular risk management.
Background:
The comorbidity of coronary artery disease (CAD) and type 2 diabetes mellitus (T2DM) presents significant challenges in clinical management, particularly regarding glycemic control. The clinical management of CAD complicated by T2DM requires coordinated glycemic control, as poor management can exacerbate cardiovascular risks and increase morbidity and mortality. While endocrinologists traditionally manage diabetes, cardiologists are increasingly involved due to the cardiovascular risks associated with poor glycemic control. This study explores the current practices of glycemic management by cardiologists and endocrinologists in patients with CAD and T2DM, focusing on treatment intensification in a Chinese hospital setting.
Methods:
This cross-sectional study included 1,074 hospitalized patients with both CAD and T2DM, admitted to the Cardiology Department of Ruijin Hospital between January 2021 and December 2023. Data were retrospectively collected from electronic medical records, including demographic information, clinical characteristics, and treatment interventions. Patients were stratified by year, and differences in treatment strategies between cardiologists and endocrinologists were analyzed. Glycemic control was assessed using HbA1c levels, with treatment intensification defined by any adjustment in antidiabetic therapy and consideration for comprehensive cardiovascular risk factors.
Results:
Endocrinologists were significantly more likely to initiate treatment intensification, especially in cases of severe hyperglycemia (HbA1c ≥9.0%), while cardiologists' role in glycemic management was limited, with a preference for outpatient endocrinology referrals over in-hospital adjustments. Despite improvements in glycemic control, the percentage of patients achieving comprehensive cardiovascular risk management targets remained low.
Conclusion:
This study underscored the distinct yet complementary roles of cardiologists and endocrinologists in managing glycemic control among patients with CAD and T2DM, noting endocrinologists' more active involvement in treatment intensification. Future integrated care models should harness the unique expertise of both specialties to optimize patient outcomes, better address glycemic control needs, and enhance overall cardiovascular risk management in this high-risk patient population.
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