Completion of annual diabetes care processes and mortality: a cohort study using the National Diabetes Audit for England and Wales

Holman, N. et al. (2021) Completion of annual diabetes care processes and mortality: a cohort study using the National Diabetes Audit for England and Wales. Diabetes, Obesity and Metabolism, 23(12), pp. 2728-2740. (doi: 10.1111/dom.14528) (PMID:34405512)

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Abstract

Aims: Guidelines recommend that diabetes care processes (HbA1c, creatinine, cholesterol, BP, BMI, smoking habit, urinary albumin, retinal and foot examinations) are performed at least annually. This analysis assesses if their completion 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 with type 2 diabetes, aged 17–99 years on 1st January 2009, diagnosed before 1st January 2009 and alive on 1st April 2013 was followed to 31st December 2019. Cox proportional hazards models adjusting for demographic characteristics, smoking, HbA1c, BP, serum cholesterol, BMI, duration of diagnosis, eGFR, prior myocardial infarction, stroke, heart failure, respiratory disease and cancer, investigated whether care processes recorded 1st January 2009 to 31st March 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 less, compared to eight, care processes (retinal screening not included as data not reliable) had a mortality hazard ratio of 1.37 (95% 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 hazard ratio 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.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Sattar, Professor Naveed and Holman, Ms Naomi
Authors: Holman, N., Knighton, P., O'Keefe, J., Wild, S. H., Brewster, S., Price, H., Patel, K., Hanif, W., Patel, V., Gregg, E. W., Holt, R. I.G., Gadsby, R., Khunti, K., Valabhji, J., Young, B., and Sattar, N.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Diabetes, Obesity and Metabolism
Publisher:Wiley
ISSN:1462-8902
ISSN (Online):1463-1326
Published Online:17 August 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in Diabetes, Obesity and Metabolism 23(12): 2728-2740
Publisher Policy:Reproduced under a Creative Commons Licence

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
303944BHF Centre of ExcellenceRhian TouyzBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science
303944BHF Centre of ExcellenceRhian TouyzBritish Heart Foundation (BHF)RE/18/6/34217CAMS - Cardiovascular Science