Good quality diabetes care reduces CV event risk
MedWire News: Achieving good quality diabetes care, as assessed by a simple score, can significantly reduce cardiovascular (CV) event risk in patients with Type 2 diabetes, suggest findings from the QUASAR study.
The Italian "Associazione Medici Diabetologi" set up the QUASAR (Quality Assessment Score and Cardiovascular Outcomes in Italian Diabetes Patients) study to evaluate whether a simple quality-of-care summary score could predict CV event risk in 5181 patients with Type 2 diabetes attending 67 centers across Italy.
The score ranged from 0-40 points based on attainment of a combination of factors, namely: mean level and frequency of measurement of glycated hemoglobin (HbA1c); mean level and frequency of measurement of blood pressure; mean level of low-density lipoprotein cholesterol and frequency of lipid measurement; frequency of testing for and presence of microalbuminuria; and presence/absence of treatment with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers.
The patients were followed-up for a mean period of 28 months, during which time 477 (9.2%) developed a CV event (angina, myocardial infarction, stroke, transient ischemic attack, coronary revascularization, lower-limb complications, or CV death).
The patients were divided into three groups according to QUASAR score - below 15 (n=345), 15-25 (n=3531), and above 25 (n=1305), with lower score reflecting reduced quality of care. Maria Rossi (Consorzio Mario Negri Sud, Chieti, Italy) and colleagues report that the respective incidence of CV events per 1000 person years in these groups was 62.4, 41.0, and 36.7.
Compared with patients with a score of above 25, those with a score below 15 were a significant 84% more likely to experience a CV event during follow-up. Similarly, patients with a score of 15-25 were a significant 17% more likely to have a CV event than those with a higher score.
The team notes that there was substantial variation in mean QUASAR scores between different centers, 25% of which Rossi et al believe can be attributed to differences in score setting characteristics between centers.
"Our study documented a close relationship between quality of diabetes care and long-term outcomes," write the authors.
They conclude: "Our findings support the use of the indicators identified as an important tool to assess the level of care provided within systems of care to populations of patients with diabetes."
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By Helen Albert