Overall quality of care predicts the variability of key risk factors for complications in type 2 diabetes

An observational, longitudinal retrospective study

Antonio Ceriello, Maria Chiara Rossi, Salvatore De Cosmo, Giuseppe Lucisano, Roberto Pontremoli, Paola Fioretto, Carlo Giorda, Antonio Pacilli, Francesca Viazzi, Giuseppina Russo, Antonio Nicolucci

Research output: Contribution to journalArticle

Abstract

An association between variability in clinical parameters (HbA 1c , blood pressure, cholesterol, and uric acid) and risk of complications in type 2 diabetes has been reported. In this analysis, we investigated to what extent such variability is associated with overall quality of care. RESEARCH DESIGN AND METHODS The quality of care summary score (Q-score) represents a validated, overall quality of care indicator ranging between 0 and 40; the higher the score, the better the quality of care provided by the diabetes center. We identified patients with five or more measurements of clinical parameters after the assessment of the Q-score. Multiple linear regression analyses assessed the role of the Q-score in predicting the variability of the different parameters. RESULTS Overall, 273,888 patients were analyzed. The variability of all the parameters systematically increased with decreasing Q-score values. At multivariate linear regression analysis, compared with a Q-score >25, a score <15 was associated with a significantly larger variation in HbA 1c , blood pressure, uric acid, total cholesterol, and LDL cholesterol and a lower variation in HDL cholesterol. The analysis of standardized b coefficients show that the Q-score has a larger impact on the variability of HbA 1c (0.34; P < 0.0001), systolic blood pressure (0.21; P < 0.0001), total cholesterol (0.21; P < 0.0001), and LDL cholesterol (0.20; P < 0.0001). CONCLUSIONS The variability of risk factors for diabetic complications is associated with quality of care. Quality of care improvement initiatives should be targeted to increase the achievement of the recommended target while reducing such variability.

Original languageEnglish
Pages (from-to)514-519
Number of pages6
JournalDiabetes Care
Volume42
Issue number4
DOIs
Publication statusPublished - Apr 1 2019

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Quality of Health Care
Type 2 Diabetes Mellitus
Longitudinal Studies
Retrospective Studies
Blood Pressure
Cholesterol
Uric Acid
LDL Cholesterol
Linear Models
Regression Analysis
Diabetes Complications
Quality Improvement
HDL Cholesterol

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialised Nursing

Cite this

Overall quality of care predicts the variability of key risk factors for complications in type 2 diabetes : An observational, longitudinal retrospective study. / Ceriello, Antonio; Rossi, Maria Chiara; De Cosmo, Salvatore; Lucisano, Giuseppe; Pontremoli, Roberto; Fioretto, Paola; Giorda, Carlo; Pacilli, Antonio; Viazzi, Francesca; Russo, Giuseppina; Nicolucci, Antonio.

In: Diabetes Care, Vol. 42, No. 4, 01.04.2019, p. 514-519.

Research output: Contribution to journalArticle

Ceriello, Antonio ; Rossi, Maria Chiara ; De Cosmo, Salvatore ; Lucisano, Giuseppe ; Pontremoli, Roberto ; Fioretto, Paola ; Giorda, Carlo ; Pacilli, Antonio ; Viazzi, Francesca ; Russo, Giuseppina ; Nicolucci, Antonio. / Overall quality of care predicts the variability of key risk factors for complications in type 2 diabetes : An observational, longitudinal retrospective study. In: Diabetes Care. 2019 ; Vol. 42, No. 4. pp. 514-519.
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AU - Lucisano, Giuseppe

AU - Pontremoli, Roberto

AU - Fioretto, Paola

AU - Giorda, Carlo

AU - Pacilli, Antonio

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