Guideline adherence and health outcomes in diabetes mellitus type 2 patients: a cross-sectional study

Wesselink, Sandra F. Oude; Lingsma, Hester F.; Robben, Paul; Mackenbach, Johan P.

doi:10.1186/s12913-014-0669-z

Cited by 37 publications

(40 citation statements)

References 21 publications

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“…Similar data have been described by Wesselink et al in the Netherlands [28] and by Sidorenkov et al, in a systematic review, thus pointing out to the need for robust indicators of health care quality [29]. In addition, it is worth noting that the results are not direct measures of the initiatives of the health professionals and may be influenced by other factors, such as lifestyle and socioeconomic circumstances, over which the institutions and care providers have no control [30].…”

Section: Discussionsupporting

confidence: 91%

Quality of Care of Patients with Diabetes in Primary Health Services in Southeast Brazil

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Costa

Colugnati

et al. 2017

Journal of Environmental and Public Health

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Background Diabetes management involves multiple aspects that go beyond drug therapy as a way of providing high quality care. The objective of this study was to describe quality of care indicators for individuals with diabetes in southeast Brazil and to explore associations among these indicators. Methods In this cross-sectional, observational study, health care providers filled out a questionnaire addressing health care structure and processes at 14 primary health care units (PHCUs). Clinical and laboratory data of diabetic patients attending the PHCUs and from patients referred to a secondary health care (SHC) center were collected. Results There was a shortage of professionals in 53.8% of the PHCUs besides a high proportion of problems regarding referrals to SHC. At the PHCU, glycated hemoglobin results were available only in half of the medical records. A low rate of adequate glycemic control was also observed. An association between structure and process indicators and the outcomes analyzed was not found. Conclusion Major deficiencies were found in the structure and processes of the PHCUs, in addition to unsatisfactory diabetes care outcomes. However, no association between structure, process, and outcomes was found.

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Section: Discussionsupporting

confidence: 91%

Quality of Care of Patients with Diabetes in Primary Health Services in Southeast Brazil

Simão

Costa

Colugnati

et al. 2017

Journal of Environmental and Public Health

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“…The estimated worsening of diabetes control with an increasing number of complications, disease duration and intensification of treatment, same as a worse glycaemic control in the patients treated with insulin compared to oral therapy users in the T2DM group, agrees with the previously published data (10, 12, 19). …”

Section: Discussionsupporting

confidence: 91%

“…Our data showed that 55.3% of patients achieved HbA1c < 7% which is worse than the average result in other European countries – 62.6%, reported in the Panorama study (22), but falls in between countries, where the percentage of T2DM patients reaching the target HbA1c ≤ 7 varies from 48.1 to 76.0% (10, 12, 19, 21, 23). …”

Section: Discussioncontrasting

confidence: 88%

“…The average HbA1c in the T2DM was significantly better compared to that in the T1DM group – 7.0% vs 9.1%. The results of studies, conducted in T2DM subjects, showed an average HbA1c of 7.5% in Estonia, 6.8–7.2% in Spain, 6.7% in Germany, 7.0% in Greece, 7.1% in Belgium (9–12, 17, 19). Our study revealed a very poor glycaemic control in the T1DM which, however, is in line with the meta-analysis of the registers of 11 countries published by McKnight et al, where the median HbA1c in the T1DM varied from 7.4 to 9.4% (20).…”

Section: Discussionmentioning

confidence: 99%

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Quality of diabetes care at the largest outpatient clinics in Vilnius

Visockienė

Šiaulienė

Puronaitė

et al. 2016

AML

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Background.Essential data on the quality of diabetes care needed for the development of National Diabetes Programme in Lithuania are lacking. The aim of the study was to assess the quality of diabetes care compared to the local guidelines in Vilnius, Lithuania.Materials and methods.Retrospective data collection covering the period from 2012 to 2013 was performed in 5 Vilnius outpatient clinics assessing process and outcome indicators in type 1 (T1DM) and type 2 diabetes mellitus (T2DM) subjects.Results.In a sample of 1,719 patients (58.9% women, 92.6% T2DM) the annual HbA1c assessment rate was 88.6%. Glycaemic control was significantly better in T2DM compared to T1DM patients: average HbA1c was 7.0 ± 1.4% vs 9.1 ± 1.8% and HbA1c ≤ 7% in 59 vs 9.4%, respectively (p < 0.001); referrals to an endocrinologist were recommended in 56.3% of cases.Annual screening for diabetic foot, retinopathy, nephropathy, renal function and lipids was performed in 4.6, 24.4, 2.3, 29.3 and 13.2% of patients, respectively, with higher performance rate of retinal screening and urinary microalbumin in T1DM; BMI and blood pressure were recorded for 50.2 and 97.2% of patients, respectively.Prevalence of nephropathy, polyneuropathy, retinopathy, and angiopathy was 8.4, 36.2, 10.7 and 7.7%, respectively, with the higher prevalence in T1DM.Conclusions.The analysis revealed good glycaemic control in T2DM, but insufficient in T1DM. Continuous monitoring of diabetes complications and cardiovascular risk factors did not meet the local Diabetes Care Guidelines.

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“…Annual foot care is currently recommended in patients with diabetes, 23 but adherence to this recommendation is only ~30%. 44 Thus, as the first step to improve this low adherence, those with both diabetes and CKD (particularly when albuminuria is present) may be a reasonable target to strongly encourage regular foot care. From the practical point of view, it is important that the assessment of kidney function and albuminuria is already recommended in patients with diabetes as well as in those with hypertension.…”

Section: Discussionmentioning

confidence: 99%

Measures of chronic kidney disease and risk of incident peripheral artery disease: a collaborative meta-analysis of individual participant data

Matsushita

Ballew

Coresh

et al. 2017

The Lancet Diabetes & Endocrinology

134

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Background Some evidence suggests that chronic kidney disease is a risk factor for lower-extremity peripheral artery disease. We aimed to quantify the independent and joint associations of two measures of chronic kidney disease (estimated glomerular filtration rate [eGFR] and albuminuria) with the incidence of peripheral artery disease. Methods In this collaborative meta-analysis of international cohorts included in the Chronic Kidney Disease Prognosis Consortium (baseline measurements obtained between 1972 and 2014) with baseline measurements of eGFR and albuminuria, at least 1000 participants (this criterion not applied to cohorts exclusively enrolling patients with chronic kidney disease), and at least 50 peripheral artery disease events, we analysed adult participants without peripheral artery disease at baseline at the individual patient level with Cox proportional hazards models to quantify associations of creatinine-based eGFR, urine albumin-to-creatinine ratio (ACR), and dipstick proteinuria with the incidence of peripheral artery disease (including hospitalisation with a diagnosis of peripheral artery disease, intermittent claudication, leg revascularisation, and leg amputation). We assessed discrimination improvement through c-statistics. Findings We analysed 817 084 individuals without a history of peripheral artery disease at baseline from 21 cohorts. 18 261 cases of peripheral artery disease were recorded during follow-up across cohorts (median follow-up was 7·4 years [IQR 5·7–8·9], range 2·0–15·8 years across cohorts). Both chronic kidney disease measures were independently associated with the incidence of peripheral artery disease. Compared with an eGFR of 95 mL/min per 1·73 m2, adjusted hazard ratios (HRs) for incident study-specific peripheral artery disease was 1·22 (95% CI 1·14–1·30) at an eGFR of 45 mL/min per 1·73 m2 and 2·06 (1·70–2·48) at an eGFR of 15 mL/min per 1·73 m2. Compared with an ACR of 5 mg/g, the adjusted HR for incident study-specific peripheral artery disease was 1·50 (1·41–1·59) at an ACR of 30 mg/g and 2·28 (2·12–2·44) at an ACR of 300 mg/g. The adjusted HR at an ACR of 300 mg/g versus 5 mg/g was 3·68 (95% CI 3·00–4·52) for leg amputation. eGFR and albuminuria contributed multiplicatively (eg, adjusted HR 5·76 [4·90–6·77] for incident peripheral artery disease and 10·61 [5·70–19·77] for amputation in eGFR <30 mL/min per 1·73 m2 plus ACR ≥300 mg/g or dipstick proteinuria 2+ or higher vs eGFR ≥90 mL/min per 1·73 m2 plus ACR <10 mg/g or dipstick proteinuria negative). Both eGFR and ACR significantly improved peripheral artery disease risk discrimination beyond traditional predictors, with a substantial improvement prediction of amputation with ACR (difference in c-statistic 0·058, 95% CI 0·045–0·070). Patterns were consistent across clinical subgroups. Interpretation Even mild-to-moderate chronic kidney disease conferred increased risk of incident peripheral artery disease, with a strong association between albuminuria and amputation. Clinical attention should be paid to...

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Guideline adherence and health outcomes in diabetes mellitus type 2 patients: a cross-sectional study

Cited by 37 publications

References 21 publications

Quality of Care of Patients with Diabetes in Primary Health Services in Southeast Brazil

Quality of Care of Patients with Diabetes in Primary Health Services in Southeast Brazil

Quality of diabetes care at the largest outpatient clinics in Vilnius

Measures of chronic kidney disease and risk of incident peripheral artery disease: a collaborative meta-analysis of individual participant data

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