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

Nutr Metab Cardiovasc Dis. 2008 Jan;18(1):57-65. doi: 10.1016/j.numecd.2006.04.009. Epub 2006 Jul 24.

Abstract

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 (HbA1c), 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 < or =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 < or =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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Albuminuria / etiology
  • Blood Pressure
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / physiopathology
  • Cardiovascular Diseases / prevention & control*
  • Cholesterol, LDL / blood
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Diabetes Mellitus, Type 2 / physiopathology
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin A / metabolism
  • Health Status Indicators
  • Humans
  • Incidence
  • Italy
  • Male
  • Middle Aged
  • Odds Ratio
  • Outcome and Process Assessment, Health Care*
  • Quality of Health Care*
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome

Substances

  • Cholesterol, LDL
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human