Multiple Risk Factor Control in Individuals with Type 2 Diabetes and Microalbuminuria

The overall aim of this PhD was to evaluate the long-term clinical, and cost-effectiveness of multiple risk factor control defined as intensive control of blood glucose, blood pressure and lipid levels, either singularly or in combination as a multifactorial intervention in individuals with type 2 diabetes and microalbuminuria, when compared to standard care.

The results from systematic review and meta-analysis suggested that interventions for risk factors control favour the trends towards a reduction in the risk of myocardial infarction (MI) [risk ratio (RR) 0.50; 95% confidence interval (CI) 0.20,1.22; P=0.127], stroke (RR 0.44; 95% CI 0.10,1.91; P=0.275), CV-mortality (RR 0.95; 95% CI 0.48,1.86; P=0.874) or all-cause mortality (RR 0.80; 95% CI 0.51,1.25; P=0.324). Whereas the cohort analysis of real-world data from the United Kingdom (UK) primary care provided evidence that being at blood glucose, blood pressure, and cholesterol targets was associated with an overall 47%, 25%, 42%, 55% and 42% reduction in the risk of MI, stroke, renal disease, CV-mortality, and all-cause-mortality, respectively. The findings of the economic evaluation indicated that achieving multiple risk factor control in individuals with type 2 diabetes were not cost-effective [incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) gained was £39,750, with the probability of being cost-effective was 0.3375] in a UK setting; however, in the subgroup of individuals with type 2 diabetes and microalbuminuria, achieving multiple risk factor control were potentially cost-effective [ICER per QALY gained was £1,366, with the probability of being cost-effective was 0.5100].

This thesis has assessed the long-term clinical, and cost-effectiveness of multiple risk factor control, through evidence synthesis methodologies, retrospective cohort analysis, and economic evaluation in people with type 2 diabetes and the subgroup of individuals with type 2 diabetes and microalbuminuria. However, uncertainty still surrounds the cost-effectiveness of multiple risk factor control, and further research is required.