Diabetes Care Coordination Key to Reducing Heart Disease

Since the late 1990s, the prevalence of cardiovascular disease in Sweden has plummeted, which may be attributable to more coordinated healthcare, according to a new study published by The New England Journal of Medicine.

The findings suggest that this decline has had a positive impact on patients with type 1 and type 2 diabetes, who are more likely to develop heart disease than the general population.

"This is a huge improvement and a testament to the improvements in diabetes and cardiovascular care throughout Sweden," said researcher Aidin Rawshani, MD.

Included in the study were 2.96 million individuals included in the National Diabetes Register and the Cause of Death Register. Of those patients, 37,000 patients had type 1 diabetes and 460,000 had type 2 diabetes.

The authors matched patients by age, gender, and geographic location. They noted that nearly all deaths that occurred during the study were the result of cardiovascular disease.

Between 1998 and 2014, the authors noted a drop in heart disease in the Swedish population, with a similar — but smaller – trend observed in the general population.

"We were surprised by the results, especially for persons with diabetes,” Dr Rawshani said. “Some smaller studies in the past have indicated that numbers were improving, but nothing of this magnitude.”

Among patients with type 1 diabetes, cardiovascular disease incidence was reduced 40%, while age-matched control patients without diabetes only saw a decrease of 10%, according to the study.

For those with type 2 diabetes, the prevalence of heart disease was reduced by 50%, while control patients without diabetes only had a reduction of 30%.

"One of the main findings of the study is that both deaths and the incidence of cardiovascular disease is decreasing in the population, both in matching control groups and among persons with type 1 and type 2 diabetes,” Dr Rawshani said. “One paradoxical finding is that individuals with type 2 diabetes have seen a smaller improvement over time regarding deaths compared to the controls, while persons with type 1 diabetes have made an equal improvement to the controls.”

The authors attributed the reduction in cardiovascular disease to the use of preventive treatments, advances in surgical techniques, and improved blood glucose monitoring, according to the study.

Additionally, the authors believe that diabetes care offered in Sweden works well and the country has adequate treatment guidelines. While the underlying cause of the results is unknown, the authors suggest that a more coordinated approach may be an important part of reducing cardiovascular disease among patients with diabetes, according to the study.

"Out study and analysis does not include explanations of these trends, but we believe that it is a matter of better control of risk factors, better education patients, better integrated treatment systems for individuals with chronic illnesses and individual care for persons with diabetes,” Dr Rawshani concluded. “There is often an entire team working with a patient, ensuring that their needs are met.”