Initiative for a new diabetes therapeutic approach in a Mediterranean country: the INDEED study

ABSTRACT

Aim: To assess the efficacy of a strategy to improve vascular risk management in patients with type 2 diabetes mellitus (T2DM).

Methods: This was a pilot best practice implementation enhancement programme that enrolled 578 patients with T2DM. A baseline visit was followed by a concerted effort from previously trained physicians to improve adherence to lifestyle advice and optimise drug treatment for all vascular risk factors. The patients were followed-up for 6 months. The UKPDS risk engine was used to estimate vascular risk in patients without established coronary heart disease (CHD) (n = 279).

Results: There was an improvement in compliance to lifestyle measures and increased prescription of evidence-based medication. In patients without established CHD there was a 37% reduction in estimated risk for CHD, 44% for fatal CHD, 10% for stroke and 25% for fatal stroke (p ≤ 0.003 for all comparisons vs. baseline). There was also a substantial increase in the proportion of patients with established CHD who achieved their vascular risk factor targets.

Conclusions: This is the first study to increase the adherence to multiple interventions in patients with T2DM in both primary care and hospital settings. Education of physicians and patients, distribution of guidelines/brochures, and the completion of a one-page form, motivated both physicians and patients to achieve multiple vascular risk factor goals.

Key words: :

• Awareness
• Best practice
• Cardiovascular risk calculation
• Cardiovascular risk management
• Diabetes mellitus
• Public Health

Transparency

Declaration of funding

This study was sponsored by the Regional (Bureau) Authority of the Ministry of Health for Northern Greece-Central Macedonia, which also funded a study secretary for 1 year. The working groups for the identification and treatment of T2DM of the Hellenic Atherosclerosis Society and the Greek Society of General Practitioners jointly conducted the study. The authors have not received any payments in relation to the preparation of this article. No pharmaceutical company supported or was involved with the preparation of this article.

Declaration of financial/other relationships

V.G.A., A.H., A.K. and T.P.D. have declared that they have given talks on behalf of Pfizer and Astra Zeneca. D.P.M. has declared that he has given talks on behalf of Merck Sharpe and Dohme, AstraZeneca and Solvay; that he is member of a Merck Sharpe and Dohme advisory board and that he has received travel expenses to attend medical meetings on behalf of Merck Sharpe and Dohme, AstraZeneca and Solvay, both within and outside of the UK. All of the other authors (F.I., S.D., T.V., P.V., I.M., K.T. and M.S.) have disclosed that they have no relevant financial interests.

All peer reviewers receive honoraria from CMRO for their review work. Peer Reviewer 1 has disclosed that he/she has been the recipient of sponsorship from Merck Sharpe and Dohme for attending an international meeting. Peer Reviewer 2 has disclosed that he/she has no relevant financial relationships.

Acknowledgements

The authors thank the following employees of the Regional (Bureau) Authority of the Ministry of Health for Northern Greece-Central Macedonia for their contributions to the study: A. Trichopoulou, Department Head and D. Florinis, and K. Kakafika.

The authors also thank the following physicians for acting as co-investigators and providing patient data: Zantidis A, AHEPA Hospital; Limenopoulos V and Papalexiou H, Genimatas Hospital; Antimidis G, Polygyros Hospital; Kakafika A, Hipocration Hospital; Tsitsiou E, Kilkis Hospital; Mandikou E and Kotzamani A, Langadas Health Center (HC); Dimopoulou S, Ormylia HC; Kalafati A, Krya Vrisi HC; Hartaba E, Sapes HC; Sterioula E, Strimoniko HC; Stefanidou K, Skydra HC; Ioannou D, Sohos HC; Balaouri A, Halastra HC; Papadopoulos G, Thermi HC.