Quality of diabetes care predicts the development of cardiovascular events: Results of the QuED study

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• 作者：Giorgia De Berardis ; Fabio Pellegrini ; Monica Franciosi ; Maurizio Belfiglio ; Barbara Di Nardo ; Sheldon Greenfield ; Sherrie H. Kaplan ; Maria C.E. Rossi ; Michele Sacco ; Gianni Tognoni ; Miriam Valentini ; Antonio Nicolucci ; for the QuED (Quality of Care ; Outcomes in Type 2 Diabetes) Study Group
• 关键词：Type 2 diabetes ; Quality of care ; Cardiovascular event ; Prediction score ; Process indicators ; Outcome indicators
• 刊名：Nutrition, Metabolism and Cardiovascular Diseases
• 出版年：2008
• 出版时间：January 2008
• 年：2008
• 卷：18
• 期：1
• 页码：57-65
• 全文大小：261 K

文摘

Background and aim

In the context of the QuED Study we assessed whether a quality of care summary score was able to predict the development of cardiovascular (CV) events in patients with type 2 diabetes.

Methods and results

The score was calculated using process and intermediate outcome indicators (HbA_1c, blood pressure, low-density lipoprotein cholesterol, microalbuminuria) and ranged from 0 to 40. Overall, 3235 patients were enrolled, of whom 492 developed a CV event after a median follow-up of 5 years. The incidence rate (per 1000 person-years) of CV events was 62.4 in patients with a score ≤10, 54.8 in those with a score between 15 and 20, and 39.8 in those with a score >20. In adjusted multilevel regression models, the risk to develop a CV event was 89 % greater in patients with a score of ≤10 (rate ratio [RR] = 1.89; 95 % confidence interval [CI] 1.43–2.50) and 43 % higher in those with a score between 10 and 20 (RR = 1.43; 95 % CI 1.14–1.79), as compared to those with a score >20. A difference between centers of 5 points in the mean quality score was associated with a difference of 16 % in CV event risk (RR = 0.84; 95 % CI 0.72–0.98).

Conclusion

Our study documented for the first time a close relationship between a score of quality of diabetes care and long-term outcomes.