Format

Send to

Choose Destination
See comment in PubMed Commons below
BMJ Qual Saf. 2013 Apr;22(4):339-47. doi: 10.1136/bmjqs-2012-001203. Epub 2013 Feb 5.

Treatment quality indicators predict short-term outcomes in patients with diabetes: a prospective cohort study using the GIANTT database.

Author information

1
Department of Clinical Pharmacology, University Medical Center Groningen, The Netherlands.

Abstract

OBJECTIVE:

To assess whether quality indicators for treatment of cardiovascular and renal risk factors are associated with short-term outcomes in patients with diabetes.

DESIGN:

A prospective cohort study using linear regression adjusting for confounders.

SETTING:

The GIANTT database (Groningen Initiative to Analyse Type 2 Diabetes Treatment) containing data from primary care medical records from The Netherlands.

PARTICIPANTS:

15 453 patients with type 2 diabetes mellitus diagnosed before 1 January 2008. Mean age 66.5 years, 47.5% men.

EXPOSURE:

Quality indicators assessing current treatment (CT) status or treatment intensification (TI) for patients with diabetes with elevated cardiovascular or renal risk factors.

MAIN OUTCOME MEASURES:

Low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), and albumin:creatinine ratio (ACR) before and after assessment of treatment quality.

RESULTS:

Use of lipid-lowering drugs was associated with better LDL-C levels (-0.41 mmol/litre; 95% CI -0.48 to -0.34). Use of blood pressure-lowering drugs and use of renin-angiotensin system inhibitors in patients with elevated risk factor levels was not associated with better SBP and ACR outcomes, respectively. TI was also associated with better LDL-C (-0.82 mmol/litre; CI -0.93 to -0.71) in patients with elevated LDL-C levels, and with better SBP (-1.26 mm Hg; CI -2.28 to -0.24) in patients with two elevated SBP levels. Intensification of albuminuria-lowering treatment showed a tendency towards better ACR (-2.47 mmol/mg; CI -5.32 to 0.39) in patients with elevated ACR levels.

CONCLUSIONS:

Quality indicators of TI were predictive of better short-term cardiovascular and renal outcomes, whereas indicators assessing CT status showed association only with better LDL-C outcome.

PMID:
23386729
DOI:
10.1136/bmjqs-2012-001203
[Indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for HighWire
    Loading ...
    Support Center