The Darkening Cloud of Diabetes: Do Trends in Cardiovascular Risk Management Provide a Silver Lining?

Abstract

Objective: We aimed to evaluate the changes in cardiovascular-related health care utilization (drug therapies, hospitalizations) and mortality for the diabetes population during a 9-year period in Saskatchewan, Canada.

Research Design and Methods: We identified annual diabetes prevalence rates for people ≥30 years between 1993 and 2001 from the administrative databases of Saskatchewan Health. Annual rates of evidence based drug therapies [antihypertensives, ACE inhibitors, beta-blockers, calcium channel blockers, HMG-CoAse reductase inhibitors (statins)], hospitalizations for cerebrovascular and cardiac events, and all-cause mortality were estimated. Rates were direct age- sex-standardized using the 2001 Canadian population, and trends over time were assessed using Joinpoint regression.

Results: From 1993-2001, diabetes prevalence increased 34% (4.7% to 6.5%, p<0.001) with the highest rates in males and those ≥65 years. The rate of increase in diabetes prevalence appeared to slow in those <65 years (p<0.01 for trend). Significant increased use of evidence based drug therapies were observed: 41% increase in antihypertensive agents, 97% increase in ACE inhibitors, 223% increase in statin therapies (all p<0.05 for trend). During this period both cerebrovascular and cardiac-related hospitalizations declined by 36% [9.5 vs 6.1 per 1000] and 19% [38.0 vs 30.6 per 1000] (p<0.05 for trends), respectively, with similar reductions regardless of sex. No change in all-cause mortality was observed (17.7 vs 17.8 deaths per 1000; p>0.05).

Conclusions: During our period of study, there was an increase in the utilization of evidenced based drug therapies in people with diabetes and reductions in cardiovascular-related hospitalizations. Despite this, we observed no change in all-cause mortality.