Completion of annual diabetes care processes and mortality: A cohort study using the National Diabetes Audit for England and Wales
Completion of annual diabetes care processes and mortality: A cohort study using the National Diabetes Audit for England and Wales
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.
cohort study, type 1 diabetes, type 2 diabetes
2728-2740
Holman, Naomi
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Knighton, Peter
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O'Keefe, Jackie
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Wild, Sarah H
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Hanif, Wasim
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Patel, Vinod
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Gregg, Edward W
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Holt, Richard
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Gadsby, Roger
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Khunti, Kamlesh
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Valabhji, Jonathan
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Young, Bob
3de953a3-1b8b-465d-a977-c6fd0ecbde11
Sattar, Naveed
f235df9f-4a62-4c70-a734-443596039051
December 2021
Holman, Naomi
c948a31d-8972-45d5-9d55-553ee0119428
Knighton, Peter
efb8ccb4-c91f-46c5-b7d6-81ada178c993
O'Keefe, Jackie
01bb22db-bb21-423b-b9b9-a9ee0bbcbc62
Wild, Sarah H
04abeb50-7841-46bf-a7ea-ce3649ba215d
Hanif, Wasim
486e55d6-ea90-4819-a617-632fe370edee
Patel, Vinod
d217ae55-8a55-4c71-aa88-d610e4f9383f
Gregg, Edward W
4a27b2f6-bf7d-4a0b-b850-cae178bad5f8
Holt, Richard
d54202e1-fcf6-4a17-a320-9f32d7024393
Gadsby, Roger
a8e2740d-a06e-43c0-b75a-d48067571db7
Khunti, Kamlesh
9c8c31f1-6a5c-41d6-b683-9d7d804656b6
Valabhji, Jonathan
e1c73656-d67f-4ba1-8306-e20e92c7e3ed
Young, Bob
3de953a3-1b8b-465d-a977-c6fd0ecbde11
Sattar, Naveed
f235df9f-4a62-4c70-a734-443596039051
Holman, Naomi, Knighton, Peter, O'Keefe, Jackie, Wild, Sarah H, Hanif, Wasim, Patel, Vinod, Gregg, Edward W, Holt, Richard, Gadsby, Roger, Khunti, Kamlesh, Valabhji, Jonathan, Young, Bob and Sattar, Naveed
(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), .
(doi:10.1111/dom.14528).
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.
Text
Care Processes Manuscript DOM_clean
- Accepted Manuscript
More information
Accepted/In Press date: 14 August 2021
e-pub ahead of print date: 17 August 2021
Published date: December 2021
Additional Information:
Funding Information:
The authors thank Liz Coyle, University of Glasgow, for her assistance in the preparation of this article. N.H. is currently funded by Diabetes UK and NHS England and NHS Improvement. N.H. received funding from the South Asian Health Foundation for this work. N.S. is supported by the British Heart Foundation Research Excellence Award (RE/18/6/34217).
Publisher Copyright:
© 2021 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.
Keywords:
cohort study, type 1 diabetes, type 2 diabetes
Identifiers
Local EPrints ID: 450974
URI: http://eprints.soton.ac.uk/id/eprint/450974
ISSN: 1462-8902
PURE UUID: 877902ac-1a90-4232-9e39-8fbaeef70b41
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Date deposited: 27 Aug 2021 16:33
Last modified: 17 Mar 2024 02:52
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Contributors
Author:
Naomi Holman
Author:
Peter Knighton
Author:
Jackie O'Keefe
Author:
Sarah H Wild
Author:
Wasim Hanif
Author:
Vinod Patel
Author:
Edward W Gregg
Author:
Roger Gadsby
Author:
Kamlesh Khunti
Author:
Jonathan Valabhji
Author:
Bob Young
Author:
Naveed Sattar
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