Disparities in the control of Diabetes type 2 and incidence of cardiovascular events. The APNA study

Background In Spain, the care of patients with DM2 is carried out in primary care by General Practitioners (GP) in Primary Health Care Centers. There is considerable variability among GPs following these patients. The objective of his study is to analyze the influences of variability in the control of the cardiovascular risk factors in DM2 patients in t cardiovascular events. Methods APNA is a dynamic cohort study that includes all the inhabitants of Navarra, a region of Spain with a population of 661.023 inhabitants. We studied 385 GPs and selected all DM2 patients over 17 years of age-old and performed 5 years follow-up. We collect clinical variables, visits to GPs, and analytical data from the clinical records, hospital admissions for cardiovascular events and stroke for each patient and GP we computed 4 indicators of DM2 quality of care, HbA1c < 7% (I1); % HbA1c > = 9% (I2); % BP < 140/90 mmHg (I3); % cLDL 9% control with a HR of 1.15 (CI 95% 1.03-1.29) Conclusions Adjusting by risk factors, and control variables for type 2 diabetes mellitus being attended by GP in the worst indicator cluster adds an additional 15% risk of having a cardiovascular event requiring hospitalization. Efforts should be made to improve quality of DM2 care and to reduce the disparities among GPs. Key messages There is great variability in the quality of health care for patients with type II diabetes specially in the proportion of diabetics with HbA1c higher or equal to 9% that differs greatly among GPs. Diabetic type 2 patients cared for by general practitioners in the worst quality group have a 15%.higher likelihood of having a cardiovascular event.