High adherence to recommended diabetes follow‐up procedures by general practitioners is associated with lower estimated cardiovascular risk
Aims To explore whether the general practitioners’ (GPs’) performance of recommended processes of care was associated with estimated risk of cardiovascular disease (CVD) and poor glycaemic control in patients with type 2 diabetes. Methods A cross‐sectional study from Norwegian general practice inclu...
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| Veröffentlicht in: | Diabetic medicine 2021-08, Vol.38 (8), p.e14586-n/a |
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| creator | Nøkleby, Kjersti Berg, Tore J. Mdala, Ibrahimu Buhl, Esben S. Claudi, Tor Cooper, John G. Løvaas, Karianne F. Sandberg, Sverre Jenum, Anne K. |
| description | Aims
To explore whether the general practitioners’ (GPs’) performance of recommended processes of care was associated with estimated risk of cardiovascular disease (CVD) and poor glycaemic control in patients with type 2 diabetes.
Methods
A cross‐sectional study from Norwegian general practice including 6015 people with type 2 diabetes 69 mmol/mol (>8.5%)) as outcome variables.
Results
The mean total and modifiable estimated 10‐year CVD risk was 12.3% and 3.3%, respectively. Compared with patients of GPs in the highest‐performing quintile, patients treated by GPs in the lowest quintile had an adjusted total and modifiable CVD risk that was 1.88 (95% CI 1.17–2.60) and 1.78 (1.14–2.41) percent point higher. This represents a relative mean difference of 16.6% higher total and 74.8% higher modifiable risk among patients of GPs in the lowest compared with the highest quintile. For patients with GPs in the lowest‐performing quintile, the adjusted odds of poor glycaemic control was 1.77 (1.27–2.46) times higher than that for patients with a GP in the highest quintile.
Conclusions
We found a pattern of lower CVD risk and better glycaemic control in patients of GPs performing more recommended diabetes processes of care. |
| doi_str_mv | 10.1111/dme.14586 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_crist</sourceid><recordid>TN_cdi_cristin_nora_10852_91446</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2515685950</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4126-bb1b2367577ef3f53c0fa9b6a70369b948ab60e06933893e964b6cabf869db4d3</originalsourceid><addsrcrecordid>eNp1kU1uFDEQhS0EIkNgwQXAEhtYTGK3f7q9RCEQpCA2sLb8U51x6G4Pdjej2XEBJM7ISSgyCQskvLFc-vxeVT1CnnJ2wvGcxhFOuFSdvkdWXGq5VtLw-2TFWtmsBWv5EXlU6zVjvDHCPCRHQnStlrJdkR8X6WpDXdxAgSkAnTMtEPI4whQh0pichxkq7fMw5N2v7z-XLd2WHCAuBct-T69gguIGrLowpzllfFaaKnW15pDcjDK7NG8o_odCoc5pvCkGV2LK31wNy-AKLal-eUwe9G6o8OT2Piaf355_OrtYX3589_7s9eU6SN7otffcN0K3qm2hF70SgfXOeO1aJrTxRnbOawZMGxzUCDBaeh2c7zttopdRHJPnB92ArnOa7JSLs5x1qrGGS6mReHkgcNivCzZtx1QDDIObIC_VNoor3SmjGKIv_kGv81Im7B8pJVTToS5Sr-4sc60FerstuIiyR1v7J0WLKdqbFJF9dqu4-BHiX_IuNgROD8AuDbD_v5J98-H8IPkb8m-oiQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2553528085</pqid></control><display><type>article</type><title>High adherence to recommended diabetes follow‐up procedures by general practitioners is associated with lower estimated cardiovascular risk</title><source>MEDLINE</source><source>NORA - Norwegian Open Research Archives</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Nøkleby, Kjersti ; Berg, Tore J. ; Mdala, Ibrahimu ; Buhl, Esben S. ; Claudi, Tor ; Cooper, John G. ; Løvaas, Karianne F. ; Sandberg, Sverre ; Jenum, Anne K.</creator><creatorcontrib>Nøkleby, Kjersti ; Berg, Tore J. ; Mdala, Ibrahimu ; Buhl, Esben S. ; Claudi, Tor ; Cooper, John G. ; Løvaas, Karianne F. ; Sandberg, Sverre ; Jenum, Anne K.</creatorcontrib><description>Aims
To explore whether the general practitioners’ (GPs’) performance of recommended processes of care was associated with estimated risk of cardiovascular disease (CVD) and poor glycaemic control in patients with type 2 diabetes.
Methods
A cross‐sectional study from Norwegian general practice including 6015 people with type 2 diabetes <75 years old, without CVD and their 275 GPs. The GPs were split into quintiles based on each GP’s average performance of six recommended processes of care. The quintiles were the exposure variable in multilevel regression models with 10‐year risk of cardiovascular events estimated by NORRISK 2 (total and modifiable fraction) and poor glycaemic control (HbA1c >69 mmol/mol (>8.5%)) as outcome variables.
Results
The mean total and modifiable estimated 10‐year CVD risk was 12.3% and 3.3%, respectively. Compared with patients of GPs in the highest‐performing quintile, patients treated by GPs in the lowest quintile had an adjusted total and modifiable CVD risk that was 1.88 (95% CI 1.17–2.60) and 1.78 (1.14–2.41) percent point higher. This represents a relative mean difference of 16.6% higher total and 74.8% higher modifiable risk among patients of GPs in the lowest compared with the highest quintile. For patients with GPs in the lowest‐performing quintile, the adjusted odds of poor glycaemic control was 1.77 (1.27–2.46) times higher than that for patients with a GP in the highest quintile.
Conclusions
We found a pattern of lower CVD risk and better glycaemic control in patients of GPs performing more recommended diabetes processes of care.</description><identifier>ISSN: 0742-3071</identifier><identifier>EISSN: 1464-5491</identifier><identifier>DOI: 10.1111/dme.14586</identifier><identifier>PMID: 33876447</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Cardiovascular disease ; Cardiovascular diseases ; Cardiovascular Diseases - epidemiology ; Cardiovascular Diseases - etiology ; Cardiovascular Diseases - prevention & control ; Continuity of care ; Cross-Sectional Studies ; Diabetes ; diabetes mellitus ; Diabetes mellitus (non-insulin dependent) ; Diabetes Mellitus, Type 2 - therapy ; Disease management ; Disease prevention ; Family physicians ; Female ; Follow-Up Studies ; general practice ; General Practice - standards ; General Practitioners ; Guideline Adherence ; Health behavior ; health care ; Humans ; Incidence ; Male ; Middle Aged ; Norway - epidemiology ; physicians ; practice patterns ; Practice Patterns, Physicians ; Quality control ; quality indicators ; Regression analysis ; Risk Assessment - methods ; Risk Factors ; type 2</subject><ispartof>Diabetic medicine, 2021-08, Vol.38 (8), p.e14586-n/a</ispartof><rights>2021 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK</rights><rights>2021 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.</rights><rights>2021. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>info:eu-repo/semantics/openAccess</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4126-bb1b2367577ef3f53c0fa9b6a70369b948ab60e06933893e964b6cabf869db4d3</citedby><cites>FETCH-LOGICAL-c4126-bb1b2367577ef3f53c0fa9b6a70369b948ab60e06933893e964b6cabf869db4d3</cites><orcidid>0000-0001-9806-8668</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fdme.14586$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fdme.14586$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>230,314,778,782,883,1414,26554,27911,27912,45561,45562</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33876447$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nøkleby, Kjersti</creatorcontrib><creatorcontrib>Berg, Tore J.</creatorcontrib><creatorcontrib>Mdala, Ibrahimu</creatorcontrib><creatorcontrib>Buhl, Esben S.</creatorcontrib><creatorcontrib>Claudi, Tor</creatorcontrib><creatorcontrib>Cooper, John G.</creatorcontrib><creatorcontrib>Løvaas, Karianne F.</creatorcontrib><creatorcontrib>Sandberg, Sverre</creatorcontrib><creatorcontrib>Jenum, Anne K.</creatorcontrib><title>High adherence to recommended diabetes follow‐up procedures by general practitioners is associated with lower estimated cardiovascular risk</title><title>Diabetic medicine</title><addtitle>Diabet Med</addtitle><description>Aims
To explore whether the general practitioners’ (GPs’) performance of recommended processes of care was associated with estimated risk of cardiovascular disease (CVD) and poor glycaemic control in patients with type 2 diabetes.
Methods
A cross‐sectional study from Norwegian general practice including 6015 people with type 2 diabetes <75 years old, without CVD and their 275 GPs. The GPs were split into quintiles based on each GP’s average performance of six recommended processes of care. The quintiles were the exposure variable in multilevel regression models with 10‐year risk of cardiovascular events estimated by NORRISK 2 (total and modifiable fraction) and poor glycaemic control (HbA1c >69 mmol/mol (>8.5%)) as outcome variables.
Results
The mean total and modifiable estimated 10‐year CVD risk was 12.3% and 3.3%, respectively. Compared with patients of GPs in the highest‐performing quintile, patients treated by GPs in the lowest quintile had an adjusted total and modifiable CVD risk that was 1.88 (95% CI 1.17–2.60) and 1.78 (1.14–2.41) percent point higher. This represents a relative mean difference of 16.6% higher total and 74.8% higher modifiable risk among patients of GPs in the lowest compared with the highest quintile. For patients with GPs in the lowest‐performing quintile, the adjusted odds of poor glycaemic control was 1.77 (1.27–2.46) times higher than that for patients with a GP in the highest quintile.
Conclusions
We found a pattern of lower CVD risk and better glycaemic control in patients of GPs performing more recommended diabetes processes of care.</description><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Cardiovascular Diseases - epidemiology</subject><subject>Cardiovascular Diseases - etiology</subject><subject>Cardiovascular Diseases - prevention & control</subject><subject>Continuity of care</subject><subject>Cross-Sectional Studies</subject><subject>Diabetes</subject><subject>diabetes mellitus</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>Diabetes Mellitus, Type 2 - therapy</subject><subject>Disease management</subject><subject>Disease prevention</subject><subject>Family physicians</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>general practice</subject><subject>General Practice - standards</subject><subject>General Practitioners</subject><subject>Guideline Adherence</subject><subject>Health behavior</subject><subject>health care</subject><subject>Humans</subject><subject>Incidence</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Norway - epidemiology</subject><subject>physicians</subject><subject>practice patterns</subject><subject>Practice Patterns, Physicians</subject><subject>Quality control</subject><subject>quality indicators</subject><subject>Regression analysis</subject><subject>Risk Assessment - methods</subject><subject>Risk Factors</subject><subject>type 2</subject><issn>0742-3071</issn><issn>1464-5491</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>EIF</sourceid><sourceid>3HK</sourceid><recordid>eNp1kU1uFDEQhS0EIkNgwQXAEhtYTGK3f7q9RCEQpCA2sLb8U51x6G4Pdjej2XEBJM7ISSgyCQskvLFc-vxeVT1CnnJ2wvGcxhFOuFSdvkdWXGq5VtLw-2TFWtmsBWv5EXlU6zVjvDHCPCRHQnStlrJdkR8X6WpDXdxAgSkAnTMtEPI4whQh0pichxkq7fMw5N2v7z-XLd2WHCAuBct-T69gguIGrLowpzllfFaaKnW15pDcjDK7NG8o_odCoc5pvCkGV2LK31wNy-AKLal-eUwe9G6o8OT2Piaf355_OrtYX3589_7s9eU6SN7otffcN0K3qm2hF70SgfXOeO1aJrTxRnbOawZMGxzUCDBaeh2c7zttopdRHJPnB92ArnOa7JSLs5x1qrGGS6mReHkgcNivCzZtx1QDDIObIC_VNoor3SmjGKIv_kGv81Im7B8pJVTToS5Sr-4sc60FerstuIiyR1v7J0WLKdqbFJF9dqu4-BHiX_IuNgROD8AuDbD_v5J98-H8IPkb8m-oiQ</recordid><startdate>202108</startdate><enddate>202108</enddate><creator>Nøkleby, Kjersti</creator><creator>Berg, Tore J.</creator><creator>Mdala, Ibrahimu</creator><creator>Buhl, Esben S.</creator><creator>Claudi, Tor</creator><creator>Cooper, John G.</creator><creator>Løvaas, Karianne F.</creator><creator>Sandberg, Sverre</creator><creator>Jenum, Anne K.</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><scope>3HK</scope><orcidid>https://orcid.org/0000-0001-9806-8668</orcidid></search><sort><creationdate>202108</creationdate><title>High adherence to recommended diabetes follow‐up procedures by general practitioners is associated with lower estimated cardiovascular risk</title><author>Nøkleby, Kjersti ; Berg, Tore J. ; Mdala, Ibrahimu ; Buhl, Esben S. ; Claudi, Tor ; Cooper, John G. ; Løvaas, Karianne F. ; Sandberg, Sverre ; Jenum, Anne K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4126-bb1b2367577ef3f53c0fa9b6a70369b948ab60e06933893e964b6cabf869db4d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Cardiovascular disease</topic><topic>Cardiovascular diseases</topic><topic>Cardiovascular Diseases - epidemiology</topic><topic>Cardiovascular Diseases - etiology</topic><topic>Cardiovascular Diseases - prevention & control</topic><topic>Continuity of care</topic><topic>Cross-Sectional Studies</topic><topic>Diabetes</topic><topic>diabetes mellitus</topic><topic>Diabetes mellitus (non-insulin dependent)</topic><topic>Diabetes Mellitus, Type 2 - therapy</topic><topic>Disease management</topic><topic>Disease prevention</topic><topic>Family physicians</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>general practice</topic><topic>General Practice - standards</topic><topic>General Practitioners</topic><topic>Guideline Adherence</topic><topic>Health behavior</topic><topic>health care</topic><topic>Humans</topic><topic>Incidence</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Norway - epidemiology</topic><topic>physicians</topic><topic>practice patterns</topic><topic>Practice Patterns, Physicians</topic><topic>Quality control</topic><topic>quality indicators</topic><topic>Regression analysis</topic><topic>Risk Assessment - methods</topic><topic>Risk Factors</topic><topic>type 2</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nøkleby, Kjersti</creatorcontrib><creatorcontrib>Berg, Tore J.</creatorcontrib><creatorcontrib>Mdala, Ibrahimu</creatorcontrib><creatorcontrib>Buhl, Esben S.</creatorcontrib><creatorcontrib>Claudi, Tor</creatorcontrib><creatorcontrib>Cooper, John G.</creatorcontrib><creatorcontrib>Løvaas, Karianne F.</creatorcontrib><creatorcontrib>Sandberg, Sverre</creatorcontrib><creatorcontrib>Jenum, Anne K.</creatorcontrib><collection>Wiley-Blackwell Open Access Titles</collection><collection>Wiley Free Content</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>NORA - Norwegian Open Research Archives</collection><jtitle>Diabetic medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nøkleby, Kjersti</au><au>Berg, Tore J.</au><au>Mdala, Ibrahimu</au><au>Buhl, Esben S.</au><au>Claudi, Tor</au><au>Cooper, John G.</au><au>Løvaas, Karianne F.</au><au>Sandberg, Sverre</au><au>Jenum, Anne K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>High adherence to recommended diabetes follow‐up procedures by general practitioners is associated with lower estimated cardiovascular risk</atitle><jtitle>Diabetic medicine</jtitle><addtitle>Diabet Med</addtitle><date>2021-08</date><risdate>2021</risdate><volume>38</volume><issue>8</issue><spage>e14586</spage><epage>n/a</epage><pages>e14586-n/a</pages><issn>0742-3071</issn><eissn>1464-5491</eissn><abstract>Aims
To explore whether the general practitioners’ (GPs’) performance of recommended processes of care was associated with estimated risk of cardiovascular disease (CVD) and poor glycaemic control in patients with type 2 diabetes.
Methods
A cross‐sectional study from Norwegian general practice including 6015 people with type 2 diabetes <75 years old, without CVD and their 275 GPs. The GPs were split into quintiles based on each GP’s average performance of six recommended processes of care. The quintiles were the exposure variable in multilevel regression models with 10‐year risk of cardiovascular events estimated by NORRISK 2 (total and modifiable fraction) and poor glycaemic control (HbA1c >69 mmol/mol (>8.5%)) as outcome variables.
Results
The mean total and modifiable estimated 10‐year CVD risk was 12.3% and 3.3%, respectively. Compared with patients of GPs in the highest‐performing quintile, patients treated by GPs in the lowest quintile had an adjusted total and modifiable CVD risk that was 1.88 (95% CI 1.17–2.60) and 1.78 (1.14–2.41) percent point higher. This represents a relative mean difference of 16.6% higher total and 74.8% higher modifiable risk among patients of GPs in the lowest compared with the highest quintile. For patients with GPs in the lowest‐performing quintile, the adjusted odds of poor glycaemic control was 1.77 (1.27–2.46) times higher than that for patients with a GP in the highest quintile.
Conclusions
We found a pattern of lower CVD risk and better glycaemic control in patients of GPs performing more recommended diabetes processes of care.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>33876447</pmid><doi>10.1111/dme.14586</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0001-9806-8668</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; NORA - Norwegian Open Research Archives; Wiley Online Library Journals Frontfile Complete |
| subjects | Cardiovascular disease Cardiovascular diseases Cardiovascular Diseases - epidemiology Cardiovascular Diseases - etiology Cardiovascular Diseases - prevention & control Continuity of care Cross-Sectional Studies Diabetes diabetes mellitus Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 2 - therapy Disease management Disease prevention Family physicians Female Follow-Up Studies general practice General Practice - standards General Practitioners Guideline Adherence Health behavior health care Humans Incidence Male Middle Aged Norway - epidemiology physicians practice patterns Practice Patterns, Physicians Quality control quality indicators Regression analysis Risk Assessment - methods Risk Factors type 2 |
| title | High adherence to recommended diabetes follow‐up procedures by general practitioners is associated with lower estimated cardiovascular risk |
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