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Research ArticleArticle

Cardiovascular Disease Prevention in Rheumatoid Arthritis: Compliance with Diabetes Screening Guidelines

Timothy J. Schmidt, J. Antonio Aviña-Zubieta, Eric C. Sayre, Michal Abrahamowicz, John M. Esdaile and Diane Lacaille
The Journal of Rheumatology July 2018, jrheum.170973; DOI: https://doi.org/10.3899/jrheum.170973
Timothy J. Schmidt
From the Department of Medicine, and the Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; McGill University, Montreal, Quebec, Canada. Supported by the Canadian Institute of Health Research (grant: MOP-130480 and THC-135235). Dr. Aviña-Zubieta is the British Columbia Lupus Society Research Scholar and holds a Michael Smith Foundation for Health Research Scholar award. Dr. Lacaille is supported by the Mary Pack Arthritis Chair in Rheumatology Research from the University of British Columbia and the Arthritis Society of Canada. T.J. Schmidt, MSc, Department of Medicine, University of British Columbia, and Arthritis Research Canada; J.A. Aviña-Zubieta, MD, PhD, FRCPC, Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; E.C. Sayre, PhD, Arthritis Research Canada; M. Abrahamowicz, PhD, James McGill Professor, McGill University; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; D. Lacaille, MD, MHSc, FRCPC, Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia. Address correspondence to Dr. D. Lacaille, Arthritis Research Canada, Milan Ilich Arthritis Research Centre, 5591 No. 3 Road, Richmond, British Columbia V6X 2C7, Canada. E-mail: dlacaille@arthritisresearch.ca. Accepted for publication March 2, 2018.
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J. Antonio Aviña-Zubieta
From the Department of Medicine, and the Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; McGill University, Montreal, Quebec, Canada. Supported by the Canadian Institute of Health Research (grant: MOP-130480 and THC-135235). Dr. Aviña-Zubieta is the British Columbia Lupus Society Research Scholar and holds a Michael Smith Foundation for Health Research Scholar award. Dr. Lacaille is supported by the Mary Pack Arthritis Chair in Rheumatology Research from the University of British Columbia and the Arthritis Society of Canada. T.J. Schmidt, MSc, Department of Medicine, University of British Columbia, and Arthritis Research Canada; J.A. Aviña-Zubieta, MD, PhD, FRCPC, Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; E.C. Sayre, PhD, Arthritis Research Canada; M. Abrahamowicz, PhD, James McGill Professor, McGill University; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; D. Lacaille, MD, MHSc, FRCPC, Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia. Address correspondence to Dr. D. Lacaille, Arthritis Research Canada, Milan Ilich Arthritis Research Centre, 5591 No. 3 Road, Richmond, British Columbia V6X 2C7, Canada. E-mail: dlacaille@arthritisresearch.ca. Accepted for publication March 2, 2018.
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Eric C. Sayre
From the Department of Medicine, and the Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; McGill University, Montreal, Quebec, Canada. Supported by the Canadian Institute of Health Research (grant: MOP-130480 and THC-135235). Dr. Aviña-Zubieta is the British Columbia Lupus Society Research Scholar and holds a Michael Smith Foundation for Health Research Scholar award. Dr. Lacaille is supported by the Mary Pack Arthritis Chair in Rheumatology Research from the University of British Columbia and the Arthritis Society of Canada. T.J. Schmidt, MSc, Department of Medicine, University of British Columbia, and Arthritis Research Canada; J.A. Aviña-Zubieta, MD, PhD, FRCPC, Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; E.C. Sayre, PhD, Arthritis Research Canada; M. Abrahamowicz, PhD, James McGill Professor, McGill University; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; D. Lacaille, MD, MHSc, FRCPC, Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia. Address correspondence to Dr. D. Lacaille, Arthritis Research Canada, Milan Ilich Arthritis Research Centre, 5591 No. 3 Road, Richmond, British Columbia V6X 2C7, Canada. E-mail: dlacaille@arthritisresearch.ca. Accepted for publication March 2, 2018.
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Michal Abrahamowicz
From the Department of Medicine, and the Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; McGill University, Montreal, Quebec, Canada. Supported by the Canadian Institute of Health Research (grant: MOP-130480 and THC-135235). Dr. Aviña-Zubieta is the British Columbia Lupus Society Research Scholar and holds a Michael Smith Foundation for Health Research Scholar award. Dr. Lacaille is supported by the Mary Pack Arthritis Chair in Rheumatology Research from the University of British Columbia and the Arthritis Society of Canada. T.J. Schmidt, MSc, Department of Medicine, University of British Columbia, and Arthritis Research Canada; J.A. Aviña-Zubieta, MD, PhD, FRCPC, Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; E.C. Sayre, PhD, Arthritis Research Canada; M. Abrahamowicz, PhD, James McGill Professor, McGill University; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; D. Lacaille, MD, MHSc, FRCPC, Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia. Address correspondence to Dr. D. Lacaille, Arthritis Research Canada, Milan Ilich Arthritis Research Centre, 5591 No. 3 Road, Richmond, British Columbia V6X 2C7, Canada. E-mail: dlacaille@arthritisresearch.ca. Accepted for publication March 2, 2018.
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John M. Esdaile
From the Department of Medicine, and the Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; McGill University, Montreal, Quebec, Canada. Supported by the Canadian Institute of Health Research (grant: MOP-130480 and THC-135235). Dr. Aviña-Zubieta is the British Columbia Lupus Society Research Scholar and holds a Michael Smith Foundation for Health Research Scholar award. Dr. Lacaille is supported by the Mary Pack Arthritis Chair in Rheumatology Research from the University of British Columbia and the Arthritis Society of Canada. T.J. Schmidt, MSc, Department of Medicine, University of British Columbia, and Arthritis Research Canada; J.A. Aviña-Zubieta, MD, PhD, FRCPC, Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; E.C. Sayre, PhD, Arthritis Research Canada; M. Abrahamowicz, PhD, James McGill Professor, McGill University; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; D. Lacaille, MD, MHSc, FRCPC, Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia. Address correspondence to Dr. D. Lacaille, Arthritis Research Canada, Milan Ilich Arthritis Research Centre, 5591 No. 3 Road, Richmond, British Columbia V6X 2C7, Canada. E-mail: dlacaille@arthritisresearch.ca. Accepted for publication March 2, 2018.
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Diane Lacaille
From the Department of Medicine, and the Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; McGill University, Montreal, Quebec, Canada. Supported by the Canadian Institute of Health Research (grant: MOP-130480 and THC-135235). Dr. Aviña-Zubieta is the British Columbia Lupus Society Research Scholar and holds a Michael Smith Foundation for Health Research Scholar award. Dr. Lacaille is supported by the Mary Pack Arthritis Chair in Rheumatology Research from the University of British Columbia and the Arthritis Society of Canada. T.J. Schmidt, MSc, Department of Medicine, University of British Columbia, and Arthritis Research Canada; J.A. Aviña-Zubieta, MD, PhD, FRCPC, Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; E.C. Sayre, PhD, Arthritis Research Canada; M. Abrahamowicz, PhD, James McGill Professor, McGill University; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia; D. Lacaille, MD, MHSc, FRCPC, Arthritis Research Canada, and Division of Rheumatology, Department of Medicine, University of British Columbia. Address correspondence to Dr. D. Lacaille, Arthritis Research Canada, Milan Ilich Arthritis Research Centre, 5591 No. 3 Road, Richmond, British Columbia V6X 2C7, Canada. E-mail: dlacaille@arthritisresearch.ca. Accepted for publication March 2, 2018.
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Abstract

Objective To evaluate compliance with diabetes screening guidelines for cardiovascular disease (CVD) prevention in rheumatoid arthritis (RA) compared to the general population.

Methods We conducted the first longitudinal study of a population-based RA cohort including all prevalent RA cases in British Columbia between 1996 and 2006 and followed until 2010, with matched general population comparators. Using administrative data, we measured compliance with general population guidelines [i.e., testing plasma glucose (PG) at least once every 3 years after age 45] after excluding individuals with previous diabetes. Followup was divided into 3-year eligibility periods. Compliance was measured as the proportion of periods with ≥ 1 PG test performed. OR (95% CI) of compliance in RA (vs general population) was calculated using generalized estimating equation models, adjusting for age and sex. Mean compliance rate per patient was also calculated and compared using the Mann-Whitney U test.

Results Analysis included 22,624 individuals with RA, contributing 48,724 three-year eligibility periods; and 22,579 people in a general population group, contributing 51,081 three-year eligibility periods. PG was measured in 72.3% (SD 37%) of the eligible time periods in the RA sample and in 70.4% (SD 38%) for the general population (OR 1.05, 95% CI 1.02–1.09, p < 0.0001). RA individuals met recommended screening guidelines in 71.4% of their eligible periods, compared to 70.6% (p < 0.001). Screening improved over time in RA relative to the general population. Family physicians ordered nearly all the PG tests.

Conclusion Compliance with general population guidelines for diabetes screening in RA was sub-optimal, with little difference relative to the general population, despite a higher risk of CVD and diabetes.

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Cardiovascular Disease Prevention in Rheumatoid Arthritis: Compliance with Diabetes Screening Guidelines
Timothy J. Schmidt, J. Antonio Aviña-Zubieta, Eric C. Sayre, Michal Abrahamowicz, John M. Esdaile, Diane Lacaille
The Journal of Rheumatology Jul 2018, jrheum.170973; DOI: 10.3899/jrheum.170973

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Cardiovascular Disease Prevention in Rheumatoid Arthritis: Compliance with Diabetes Screening Guidelines
Timothy J. Schmidt, J. Antonio Aviña-Zubieta, Eric C. Sayre, Michal Abrahamowicz, John M. Esdaile, Diane Lacaille
The Journal of Rheumatology Jul 2018, jrheum.170973; DOI: 10.3899/jrheum.170973
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