medwireNews: Poorer quality of care is linked to greater variability in clinical parameters associated with the risk for complications among patients with type 2 diabetes, researchers report.
Antonio Ceriello (Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain) and colleagues used electronic medical records from 273,888 patients attending one of 300 Italian diabetes clinics between 2005 and 2011 to assess the relationship between a quality of care summary score (Q-score) and variability in known predictors of complications over an average follow-up of 2.5 years.
The interaction between variability in risk factors – such as glycated hemoglobin (HbA1c), blood pressure, and lipids – and the development of diabetes complications “has been documented in an increasing number of studies in the recent years,” say the study authors.
They explain that the Q-score, which “is based on a combination of process and outcome indicators relative to HbA1c, blood pressure, LDL [low-density lipoprotein] cholesterol, and microalbuminuria,” ranges from 0 to 40 points, with a higher score corresponding to better quality of care.
As reported in Diabetes Care, multivariate linear regression analysis demonstrated that the Q-score was a significant independent predictor of variability in HbA1c, systolic and diastolic blood pressure, uric acid, total cholesterol, high- and low-density lipoprotein cholesterol, triglycerides, and bodyweight.
For HbA1c, patients with a Q-score below 15 points had significantly higher average levels (8.0 vs 7.1%), as well as greater variability as indicated by the standard deviation (SD; 0.7 vs 0.5%), relative to those with a Q-score above 25 points.
Similarly, mean systolic (141.6 vs 133.9 mmHg) and diastolic (78.8 vs 76.8 mmHg) blood pressure, along with variability (SD) in these parameters (12.9 vs 11.4 mmHg and 6.7 vs 6.3 mmHg, respectively), were significantly higher among patients with a Q-score below 15 points compared with above 25 points. The researchers observed comparable results for total and LDL cholesterol, uric acid, and bodyweight measurements.
Ceriello and team add that patients receiving intermediate quality of care – indicated by a Q-score of 15–25 points – also had significantly greater variability in HbA1c, blood pressure, total and LDL cholesterol, and uric acid than patients with a Q-score above 25.
In an analysis of standardized beta coefficients, the investigators demonstrated that of all the variables studied, quality of care had the largest impact on HbA1c levels, followed by systolic blood pressure, total cholesterol, and LDL cholesterol.
Together, these findings suggest that a low Q-score “is mainly driven by the difficulty in reaching satisfactory HbA1c, blood pressure, and lipid levels,” say the researchers, adding that “variability in the clinical parameters can derive from poor quality of care or poor compliance with medical recommendations.”
And they conclude that “any effort should be devoted to keeping the parameters constantly within ranges recommended by guidelines over time, with timely therapy intensification whenever needed.”
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