Defeat Diabetes

2 mins read

Exciting updates to the Australian Cardiovascular Disease (CVD) risk calculator put Australians with type 2 diabetes in the spotlight, with the new tool offering a more precise way to assess heart disease and stroke risk.

People with diabetes face a significantly higher risk of cardiovascular disease (CVD) compared to the general population. The new Australian CVD risk calculator (2023 guidelines) strongly focuses on diabetes. By including diabetes-specific factors, the calculator provides a much more accurate assessment of an individual’s CVD risk.

Previously, CVD risk assessment for people with diabetes was limited. Now, the calculator considers:

  • Glycated hemoglobin (HbA1c) levels: A measurement of average blood glucose control over the past 2-3 months. Higher HbA1c indicates poorer blood glucose control and a higher risk of CVD complications.
  • Time since diabetes diagnosis: The longer someone has had diabetes, the greater their risk of developing CVD complications.
  • Kidney function (uACR and eGFR): These tests assess kidney health. Poor kidney function is associated with increased CVD risk, especially in people with diabetes.
  • Insulin Use: People who require insulin therapy are generally at higher risk of CVD compared to those managed with oral medications or lifestyle changes alone. This is because chronically high blood glucose levels are a major risk factor for CVD.

What’s changed?

This new calculator goes beyond traditional methods by considering a wider range of factors impacting your CVD risk, socioeconomic disadvantage and diabetes-specific risk factors. 

Here’s an overview of what’s changed:

Feature

Old CVD risk calculator

New CVD risk calculator (2023 Guidelines)

Risk categories

Unclear, broad categories

Defines clear risk categories: 

  • High (≥10% risk in 5 years)
  • Intermediate (5-10% risk)
  • Low (<5% risk)

Age for assessment

Limited. Did not consider diabetes-specific factors.

Expanded range:

  • 45-79 (All) 
  • 35-79 (diabetes) 
  • Individual assessment for First Nations (18-29)

Diabetes focus

Limited

For people with diabetes:

  • HbA1c (blood sugar control)
  • Time since diabetes diagnosis 
  • Kidney function measures (uACR and eGFR)
  • BMI
  • Insulin

Additional factors considered

Fewer, traditional risk factors (cholesterol, BP, smoking, family history)

More comprehensive:

  • Age, sex
  • Smoking status
  • Systolic BP
  • RC: HDL-C ratio
  • Diabetes stauts
  • CVD medicine
  • Postcode (marker of SDOH)
  • History of AF

Overall accuracy

Less precise

More accurate:

PREDICT-1° equation specifically calibrated for Australia, especially for diabetes.

Underlying model

Framingham risk equation

PREDICT-1° equation

What this means for patients

This new approach allows for earlier intervention and potentially life-extending preventive measures by identifying people with diabetes who are at a higher CVD risk. These might involve more aggressive blood glucose management, lifestyle changes, or medications specifically designed to reduce CVD risk in people with diabetes.

Overall, this update in CVD risk assessment is a major step forward for Australians with diabetes. It empowers healthcare professionals to tailor preventive strategies better and improve long-term health outcomes for their patients.

Tips for healthcare professionals

  • Focus on diabetes: Utilise the calculator's strength in assessing diabetes-specific risk factor. Consider HbA1c, diagnosis duration, and kidney function for a more precise picture.
  • Screen more, screen early: Start CVD risk assessments for patients with diabetes at 35 (earlier guidelines) and consider individual evaluations for younger First Nations adults (18-29).
  • Advocate for lifestyle changes: Encourage patients with pre-diabetes or type 2 diabetes to make sustainable lifestyle changes, including: carbohydrate restriction, regular exercise, weight management, and smoking cessation.
  • Guide patients to resources: Direct patients with pre-diabetes and type 2 diabetes to reputable online resources that can assist with diabetes management for further education and support.

Additional resources for patients

Consider recommending evidence-based dietary approaches, such as a low-carbohydrate therapeutic carbohydrate restriction (TCR) plan to your patients. The Defeat Diabetes downloadable TCR toolkit is available to support the successful implementation of lifestyle modifications into your patient’s plan. 

Further information

For more details on the new Australian CVD Risk Calculator and full guidelines, visit the CVD Check website.

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