Integrated Assessment of Pharmacological and Nutritional Cardiovascular Risk Management: Blood Pressure Control in the DIAbetes and LifEstyle Cohort Twente (DIALECT)

Abstract

Cardiovascular risk management is an integral part of treatment in Type 2 Diabetes Mellitus (T2DM), and requires pharmacological as well as nutritional management. We hypothesize that a systematic assessment of both pharmacological and nutritional management can identify targets for the improvement of treatment quality. Therefore, we analysed blood pressure (BP) management in the DIAbetes and LifEstyle Cohort Twente (DIALECT). DIALECT is an observational cohort from routine diabetes care, performed at the ZGT Hospital (Almelo and Hengelo, The Netherlands). BP was measured for 15 min with one minute intervals. Sodium and potassium intake was derived from 24-hour urinary excretion. We determined the adherence to pharmacological and non-pharmacological guidelines in patients with BP on target (BP-OT) and BP not on target (BP-NOT). In total, 450 patients were included from August 2009 until January 2016. The mean age was 63 ± 9 years, and the majority was male (58%). In total, 53% had BP-OT. In those with BP-NOT, pharmacological management was suboptimal (zero to two antihypertensive drugs) in 62% of patients, and nutritional guideline adherence was suboptimal in 100% of patients (only 8% had a sodium intake on target, 66% had a potassium intake on target, 3% had a sodium-to-potassium ratio on target, and body mass index was <30 kg/m2 in 35%). These data show pharmacological undertreatment and a low adherence to nutritional guidelines. Uncontrolled BP is common in T2DM, and our data show a window of opportunity for improving BP control, especially in nutritional management. To improve treatment quality, we advocate to incorporate the integrated monitoring of nutritional management in quality improvement cycles in routine care.

Glycaemic control in the diabetes and Lifestyle Cohort Twente: A cross‐sectional assessment of lifestyle and pharmacological management on Hba1c target achievement

“…In total, 161 patients (36%) achieved an HbA1c-OIT, of which 33 patients (7% of total population) achieved an HbA1c < 42 mmol/mol (<6%). Patients with HbA1c-NOIT had a longer median duration of type 2 diabetes than those with HbA1c-OIT (13 [8-20] vs 9 [4][5][6][7][8][9][10][11][12][13][14] years, P < .001).…”

“…The study population and study procedures have been described previously. 4 In brief, 450 patients with type 2 diabetes, aged 18+ years were included and exclusion criteria were renal replacement therapy or inability to understand the concept of informed consent. The ZGT hospital is a secondary health care centre for diabetes treatment.…”

Long Term Osmotic Mini Pump Treatment with Alpha-MSH Improves Myocardial Function in Zucker Diabetic Fatty Rats

“…These therapeutic strategies are nevertheless palliative and generally fail to restore type 2 diabetics to full health. Moreover, epidemiological studies show that incidence of this disorder has dramatically increased to epidemic proportions [ 6 , 7 , 8 , 9 ]. Numerous factors have contributed to this phenomenon, principally caused by sedentary lifestyle-related factors such as over-nutrition, lack of exercise and particularly obesity [ 10 , 11 , 12 ].…”

Physical Activity in Patients With Type 2 Diabetes: The Case for Objective Measurement in Routine Clinical Care

“…We compared the results of the Short Questionnaire to Assess Health-Enhancing Physical Activity (SQUASH) (2) and the Fitbit Flex accelerometer (3) in 50 patients with type 2 diabetes included in the Diabetes and Lifestyle Cohort Twente (DIALECT) trial, which was approved by the local institutional review board METC-Twente (NL57219.044.16) (4).…”