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Marlene Busko, for Medscape
October 25, 2022
Researchers published the study covered in this summary on Research Square as a preprint that has not yet been peer reviewed.
Researchers in Italy have developed a Web-based app called AWARE, whereby clinicians can quickly stratify cardiovascular (CV) risk of patients with type 2 diabetes as moderate, high, or very high based on criteria from the 2019 European Society of Cardiology (ESC)/European Association for the Study of Diabetes (EASD) guidelines on diabetes, prediabetes, and cardiovascular disease (CVD).
In a feasibility study of more than 2000 patients seen at diabetes clinics, clinicians entered patient data into the app, which takes about 20 seconds. Based on the data, the app classified CV risk in the cohort as very high (72.2% of patients), high (9.9%), or moderate (0.8%). However, 18.2% of patients did not fit any of the risk categories and were deemed to have moderate to high CV risk.
Mean A1c of the overall population was 7.5%, and A1c was above the recommended 7% in each of the four CV risk groups.
Only about 25% of patients with high or very high cardiovascular risk had been prescribed a sodium-glucose cotransporter-2 (SGLT2) inhibitor or a glucagon-like peptide-1 (GLP1) agonist, which the 2019 ESC/EASD guidelines recommend as first-line treatment for such patients.
In a busy clinic where patients with type 2 diabetes are typically seen during a 15-minute visit, it might not be practical to assess each patient’s CV risk using the criteria from the 2019 ESC/EASD guidelines.
However, not determining the CV risk of a patient with type 2 diabetes would miss some patients at high or very high risk who would benefit from early initiation of an SGLT2 inhibitor or GLP-1 agonist, which could delay or prevent organ damage (of the heart, kidney, and eyes).
This first feasibility study of a Web app to stratify CV risk in patients with type 2 diabetes showed that in real-world clinical practice, clinicians could use the app to rapidly and efficiently assess this risk.
The AWARE app, which is free and available online (user ID: Aware; password: Aware), has the potential to increase physician awareness of the CV risk for a particular patient with type 2 diabetes and potentially help them implement more aggressive and earlier treatment with newer medications, which could help prevent chronic severe complications and premature death.
The AWARE app, which can be downloaded onto a computer, smartphone, or tablet regardless of the operating system, was developed by the Italian company SoftwareVM on behalf of diabetes centers in the study, to assess CV risk in patients with type 2 diabetes based on 2019 ESC/EASD guideline criteria.
The app consists of a short form that takes about 20 seconds to complete with the following patient information:
Age (< 50 or ≥ 50 years old)
Diabetes duration (< 10 or ≥ 10 years)
Presence of established CVD (yes or no)
Target organ damage, yes or no for each of the following: proteinuria, chronic kidney disease (eGFR < 30 mL/min/1.73 m2), retinopathy, or left ventricular hypertrophy
Major CV risk factors, yes or no for each of the following four factors: smoking, dyslipidemia, hypertension, obesity, plus the patient’s age.

Patients with type 2 diabetes were classed as:
Very high risk: Established CVD or other target organ damage or three or more major CV risk factors
High risk: Diabetes for ≥ 10 years without target organ damage plus any additional major risk factor
Moderate risk: Young (< 50 years) with diabetes duration < 10 years, without other risk factors
Moderate to very high risk: Patients who did not fall into any of the other three categories.

In the current study, the form also had a place to record the patient’s A1c level and diabetes medication (metformin, basal insulin, rapid insulin, sulfonylurea, pioglitazone, repaglinide, acarbose, dipeptidyl peptidase 4 (DPP4) inhibitor, SGLT2 inhibitor, GLP1 agonist, or no current therapy).
The app was used to calculate CV risk and determine A1c level and current pharmacologic treatment of 2243 consecutive patients with type 2 diabetes who attended diabetology centers in Lombardy from November 2020 to April 2021.
Patients with a very high CV risk were more often ≥ 65 years old (68.9%). More than half had had diabetes for ≥ 10 years (56.8%). Many had a history of CV disease (41.4%) or organ damage (35.5%). They also had a higher number of CV risk factors than patients in other risk groups.
In general, patients with moderate to high CV risk generally had diabetes for < 10 years (96%) and were younger (55% were 50-60 years old), with no history of CV disease and no organ damage, and had one to two CV risk factors (89%).
GLP-1 agonists or SGLT2 inhibitors had only been prescribed to 26.3% of the patients with very high CV risk and 24.7% of the patients with high CV risk.
The researchers did not note any potential study limitations.
The study did not receive commercial funding.
The authors report no relevant financial disclosures.
This is a summary of a preprint research study AWARE. A web application to rapidly assess cardiovascular risk in type 2 diabetes mellitus, written by researchers mainly from the University of Milan, Lombardy, Italy. Preprints from Research Square are provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on Research Square.
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Cite this: App Quickly Gauges Cardiovascular Risk in Patients With Diabetes – Medscape – Oct 25, 2022.
Freelance writer, Medscape

Disclosure: Marlene Busko has disclosed no relevant financial relationships.
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