Naomi Holman1, Peter Knighton2, Jackie OʼKeefe2, Sarah H Wild3, Sarah Brewster4, Hermione Price4, Kiran Patel5,6,7, Wasim Hanif8, Vinod Patel6,9,10, Edward W Gregg11, Richard I G Holt12, Roger Gadsby6, Kamlesh Khunti13, Jonathan Valabhji14,15,16, Bob Young17, Naveed Sattar1. 1. Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK. 2. Analytical Services - Population Health, Clinical Audit and Specialist Care, NHS Digital, Leeds, UK. 3. College of Medicine and Veterinary Medicine, Usher Institute, University of Edinburgh, Edinburgh, UK. 4. West Hampshire Community Diabetes Service, Southern Health NHS Foundation Trust, Lyndhurst, UK. 5. University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK. 6. Warwick Medical School, University of Warwick, Warwick, UK. 7. Coventry University, Coventry, UK. 8. University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. 9. Diabetes and Endocrinology Centre, George Eliot Hospital NHS Trust, Nuneaton, UK. 10. West Midlands Clinical Networks and Clinical Senate, NHS England and NHS Improvement - Midlands, Birmingham, UK. 11. School of Public Health, Imperial College, London, UK. 12. Human Development and Health, Faculty of Medicine, University of Southampton and Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK. 13. Diabetes Research Centre, University of Leicester, Leicester, UK. 14. NHS England and NHS Improvement, London, UK. 15. Department of Diabetes and Endocrinology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK. 16. Division of Metabolism, Digestion and Reproduction, Imperial College London, London, UK. 17. Diabetes UK, London, UK.
Abstract
AIM: To conduct an analysis to assess whether the completion of recommended diabetes care processes (glycated haemoglobin [HbA1c], creatinine, cholesterol, blood pressure, body mass index [BMI], smoking habit, urinary albumin, retinal and foot examinations) at least annually is associated with mortality. MATERIALS AND METHODS: A cohort from the National Diabetes Audit of England and Wales comprising 179 105 people with type 1 and 1 397 790 people with type 2 diabetes, aged 17 to 99 years on January 1, 2009, diagnosed before January 1, 2009 and alive on April 1, 2013 was followed to December 31, 2019. Cox proportional hazards models adjusting for demographic characteristics, smoking, HbA1c, blood pressure, serum cholesterol, BMI, duration of diagnosis, estimated glomerular filtration rate, prior myocardial infarction, stroke, heart failure, respiratory disease and cancer, were used to investigate whether care processes recorded January 1, 2009 to March 31, 2010 were associated with subsequent mortality. RESULTS: Over a mean follow-up of 7.5 and 7.0 years there were 26 915 and 388 093 deaths in people with type 1 and type 2 diabetes, respectively. Completion of five or fewer, compared to eight, care processes (retinal screening not included as data were not reliable) had a mortality hazard ratio (HR) of 1.37 (95% confidence interval [CI] 1.28-1.46) in people with type 1 and 1.32 (95% CI 1.30-1.35) in people with type 2 diabetes. The HR was higher for respiratory disease deaths and lower in South Asian ethnic groups. CONCLUSIONS: People with diabetes who have fewer routine care processes have higher mortality. Further research is required into whether different approaches to care might improve outcomes for this high-risk group.
AIM: To conduct an analysis to assess whether the completion of recommended diabetes care processes (glycated haemoglobin [HbA1c], creatinine, cholesterol, blood pressure, body mass index [BMI], smoking habit, urinary albumin, retinal and foot examinations) at least annually is associated with mortality. MATERIALS AND METHODS: A cohort from the National Diabetes Audit of England and Wales comprising 179 105 people with type 1 and 1 397 790 people with type 2 diabetes, aged 17 to 99 years on January 1, 2009, diagnosed before January 1, 2009 and alive on April 1, 2013 was followed to December 31, 2019. Cox proportional hazards models adjusting for demographic characteristics, smoking, HbA1c, blood pressure, serum cholesterol, BMI, duration of diagnosis, estimated glomerular filtration rate, prior myocardial infarction, stroke, heart failure, respiratory disease and cancer, were used to investigate whether care processes recorded January 1, 2009 to March 31, 2010 were associated with subsequent mortality. RESULTS: Over a mean follow-up of 7.5 and 7.0 years there were 26 915 and 388 093 deaths in people with type 1 and type 2 diabetes, respectively. Completion of five or fewer, compared to eight, care processes (retinal screening not included as data were not reliable) had a mortality hazard ratio (HR) of 1.37 (95% confidence interval [CI] 1.28-1.46) in people with type 1 and 1.32 (95% CI 1.30-1.35) in people with type 2 diabetes. The HR was higher for respiratory disease deaths and lower in South Asian ethnic groups. CONCLUSIONS: People with diabetes who have fewer routine care processes have higher mortality. Further research is required into whether different approaches to care might improve outcomes for this high-risk group.
Authors: Mekha Mathew; Jeremy van Vlymen; Bernardo Meza-Torres; William Hinton; Gayathri Delanerolle; Ivelina Yonova; Michael Feher; Xuejuan Fan; Harshana Liyanage; Mark Joy; Fabrizio Carinci; Simon de Lusignan Journal: JMIR Res Protoc Date: 2022-04-22