Impact of Simulated Risk Factor Management on Cardiovascular Disease and Costs in Type 2 Diabetes Using the ABC Model

We evaluated the impact of scenario-based multifactorial control on the 3-year incidence of fatal/non-fatal cardiovascular disease (CVD) and associated healthcare costs in Asian patients with type 2 diabetes (T2D).

We applied the validated 'ABC' model to simulate the 3-year impact of attaining multiple treatment targets (HbA_1c < 7%, blood pressure [BP] < 130/80 mmHg, risk-stratified LDL-C target [ABC], smoking cessation and weight reduction) on the incidence of fatal/non-fatal CVD (ischaemic heart disease and stroke) in patients with T2D enrolled from 11 Asian countries/jurisdictions in the Joint Asia Diabetes Evaluation (JADE) Register. We estimated the costs of these simulated CVD events and potential cost savings with multifactorial intervention.

Amongst 103 958 patients with T2D (53.4% men, 12.0% current smokers, mean [SD] age 57.6 [11.8], HbA_1c 7.96 [1.87], systolic BP 132.0 [17.4] mmHg, LDL-C 2.6 [0.95] mmol/L, BMI 26.2 [4.5] kg/m²), 17 151 (16.5%) had prior CVD and 86 807 (83.5%) had no CVD at baseline. In the CVD group, 1.5% achieved all three ABC targets and 5.1% in the nonCVD group at baseline. In the CVD group, the estimated incidence rate for CVD was 61.60 per 1000-person-years (PY), and 11.65 per 1000-PY in the non-CVD group. Simulated achievement of all three ABC targets reduced the incidence rates by 35.1%-40.01% per 1000-PY in the CVD group and by 30.2%-8.13% per 1000-PY in the non-CVD group. In China, these scenario-based simulations might avert 1 177 682 CVD events per year with a potential saving of US$ 11 292 823 476.

Multifactorial management of cardiometabolic risk factors may have a substantial impact on CVD prevention, with cost savings in patients with T2D.