AWARE. A web application to rapidly assess cardiovascular risk in Type 2 Diabetes Mellitus.

Abstract

Abstract Background Cardiovascular (CV) risk assessment may result unpractical in real-world clinical practice, although being considered a key step for choosing appropriate therapies for patients with Type 2 Diabetes Mellitus (T2DM). In order to streamline this process in the diabetes clinic, we have developed the web application “AWARE”. Methods The AWARE App is based on 2019 ESC/EASD criteria for cardiovascular risk (CVR) stratification in T2DM, which divides patients into 3 categories: very high (VHCVR), high (HCVR) and moderate (MCVR) CV risk. In this retrospective clinical study, we employed the AWARE App to assess CV risk of consecutive T2DM patients attending Diabetes Clinics in Lombardy (Italy). Results Overall, 2243 T2DM patients underwent CV risk assessment with the AWARE App. 1619 patients (72.2%) had a VHCVR, 199 (8.9%) an HCVR, and only 17 (0.8%) had an MCVR. 408 patients (18.2%) did not fit into any of the ESC/EASD risk categories and we included them in the additional “moderate-to-high” (MHCVR) group. Patients with VHCVD were more frequently ≥65 years old (68.9%), with a longer disease duration (≥10 years [56.8%]), history of CV disease (41.4%), organ damage (35.5%) and higher numbers of CV risk factors compared with other risk groups. Patients with MHCVD generally had disease duration <10 years (96%), younger age (50-60 years [55%]), no history of CV disease and no organ damage, and 1-2 CV risk factors (89%). GLP-1 RA or SGLT-2i were prescribed only to 26.3% of the patients with VHCVR and to 24.7% of those with HCVR. Glycaemic control was unsatisfactory, both in the overall population and in each CV risk group (mean A1c level of 58.7 ± 13.44 mmol/mol [7.5 ± 3.4%]). Conclusions The AWARE App is a practical tool for CV risk stratification of T2DM patients in real-world clinical practice. Despite a generally severe CV risk and unsatisfactory glycaemic control, T2DM patients are rarely treated to achieve HbA1c < 7% and with newer cardioprotective medications.