Variability in the Control of Type 2 Diabetes in Primary Care and Its Association with Hospital Admissions for Vascular Events. The APNA Study.

Sara Guillen-Aguinaga,Francisco Guillen-Grima,Ines Aguinaga-Ontoso,Luis Forga,Antonio Brugos-Larumbe,Laura Guillen-Aguinaga

doi:10.3390/jcm10245854

Abstract

Type 2 diabetes (T2D) is associated with increased cardiovascular morbidity, mortality, and hospital admissions. This study aimed to analyze how the differences in delivered care (variability of glycosylated hemoglobin (HbA1c) achieved targets) affect hospital admissions for cardiovascular events (CVEs) in T2D patients. Methods: We analyzed the electronic records in primary care health centers at Navarra (Spain) and hospital admission for CVEs. We followed 26,435 patients with T2D from 2012 to 2016. The variables collected were age, sex, health center, general practitioner practice (GPP), and income. The clinical variables were diagnosis of T2D, weight, height, body mass index (BMI), blood pressure (BP), HbA1c, low-density lipoprotein cholesterol (LDL-C), smoking, and antecedents of CVEs. We calculated, in each GPP practice, the proportion of patients with HbA1c ≥ 9. A non-hierarchical K-means cluster analysis classified GPPs into two clusters according to the level of compliance with HbA1C ≥ 9% control indicators. We used logistic and Cox regressions. Results: T2D patients had a higher probability of admission for CVEs when they belonged to a GPP in the worst control cluster of HbA1C ≥ 9% (HR = 1.151; 95% CI, 1.032–1.284).

Highlights

Type 2 diabetes (T2D) is a highly prevalent disease associated with increased cardiovascular (CV) morbidity, mortality, and hospital admissions [1,2,3]
Our study found that the risk of hospital admissions for cardiovascular events (CVEs) increased by 3.4% with each year of age
The general practitioner practice (GPP) assigned to a patient had an independent effect on hospital admissions for CVEs

Summary

Introduction

Type 2 diabetes (T2D) is a highly prevalent disease associated with increased cardiovascular (CV) morbidity, mortality, and hospital admissions [1,2,3]. CV risk factors in patients with T2D are more prevalent than in the general population. CV risk factors can be modifiable and non-modifiable. Modifiable factors include glycemic control, smoking, obesity, hypertension, and dyslipidemia [4,5]. Non-modifiable factors comprise a family history of CV disease, years of T2D evolution, race, gender, age, age at T2D debut, and antecedents of cardiovascular events (CVEs) [6]. In T2D patients, low socioeconomic status is associated with higher mortality [7,8,9,10,11,12,13]

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