Quality Standards for Diabetes Care Toolkit

Implementation advice

The Cardiovascular Assessment risk calculator for people with diabetes can be found on the NZSSD website here: www.nzssd.org.nz/cvd/
Based on the current New Zealand guidelines, the following actions need to be performed to meet the Standard requirements:

cardiovascular risk assessment has been done for all men aged 45 and over

for men with known risk factors risk assessment has been done at age 35

cardiovascular risk assessment has been done for all women aged 55 and over

for women with known risk factors, risk assessment has been done at age 45

cardiovascular risk assessment has been done for Māori men at 35 years and women at 45 years

fasting lipids, HbA1c and two-seated blood pressure measurements are included in the comprehensive risk assessment

those with an HbA1c of 41 to 49 mmol/mol have been advised about reducing their risk of diabetes.

Following cardiovascular risk assessment:

those with a five-year risk <10% have been advised to be smoke-free, eat a healthy heart diet and be physically active

risk assessment for this group has been recalculated every 5 to 10 years

those with a five-year risk of 10% to 20% have received individualised support to stop smoking, eat a cardio-protective diet and be physically active using motivational interviewing and involving relevant support programmes, eg, smoking cessation

advantages and disadvantages of BP lowering and lipid medication have been discussed and a shared decision about starting medication has been made

risk assessment for this group has been recalculated as clinically indicated. For those not on BP and lipid medication CVD risk has been assessed annually (risk 15–20%) or two-yearly (risk 10–15%)

those with a five-year risk >20% have received intensive lifestyle intervention and drug treatment (BP lowering, statins and antiplatelet therapy)

risk assessment for this group has been recalculated annually or as clinically indicated

those with established cardiovascular disease have received intensive lifestyle intervention and drug treatment (BP lowering, statins and antiplatelet therapy)

risk assessment for this group has been recalculated initially at three months and then as clinically indicated.

NB: Clinical judgment and informed patient preferences (shared decision-making) should feature in decisions about treatment for all people, and particularly for those in the ‘intermediate’ range of risk and for younger or older people. Shared treatment decisions should take into account an individual’s estimated five-year combined CVD risk and the magnitude of absolute benefits and the harms of interventions. Individuals will vary in the way they interpret these risk estimates and in their desire and willingness to act on them.