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Open Access 01-12-2021 | Diabetic Retinopathy | Research article

Associations between attainment of incentivised primary care indicators and incident diabetic retinopathy in England: a population-based historical cohort study

Authors: Ailsa J. McKay, Laura H. Gunn, Thirunavukkarasu Sathish, Eszter Vamos, Manjula Nugawela, Azeem Majeed, German Molina, Sobha Sivaprasad

Published in: BMC Medicine | Issue 1/2021

Abstract

Background

The associations between England’s incentivised primary care-based diabetes prevention activities and hard clinical endpoints remain unclear. We aimed to examine the associations between attainment of primary care indicators and incident diabetic retinopathy (DR) among people with type 2 diabetes.

Methods

A historical cohort (n = 60,094) of people aged ≥ 18 years with type 2 diabetes and no DR at baseline was obtained from the UK Clinical Practice Research Datalink (CPRD). Exposures included attainment of the Quality and Outcomes Framework (QOF) HbA1c (≤ 7.5% or 59 mmol/mol), blood pressure (≤ 140/80 mmHg), and cholesterol (≤ 5 mmol/L) indicators, and number of National Diabetes Audit (NDA) care processes completed (categorised as 0–3, 4–6, or 7–9), in 2010–2011. Outcomes were time to development of DR and sight-threatening diabetic retinopathy (STDR). Nearest neighbour propensity score matching was undertaken and Cox proportional hazards models then fitted using the matched samples. Concordance statistics were calculated for each model.

Results

8263 DR and 832 STDR diagnoses were observed over mean follow-up periods of 3.5 (SD 2.1) and 3.8 (SD 2.0) years, respectively. HbA1c and blood pressure (BP) indicator attainment were associated with lower rates of DR (adjusted hazard ratios (aHRs) 0.94 (95% CI 0.89–0.99) and 0.87 (0.83–0.92), respectively), whereas cholesterol indicator attainment was not (aHR 1.03 (0.97–1.10)). All QOF indicators were associated with lower rates of STDR (aHRs 0.74 (0.62–0.87) for HbA1c, 0.78 (0.67–0.91) for BP, and 0.82 (0.67–0.99) for cholesterol). Completion of 7–9 vs. 0–3 NDA processes was associated with fewer STDR diagnoses (aHR 0.72 (0.55–0.94)).

Conclusions

Attainment of key primary care indicators is associated with lower incidence of DR and STDR among patients with type 2 diabetes in England.

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Title: Associations between attainment of incentivised primary care indicators and incident diabetic retinopathy in England: a population-based historical cohort study
Authors: Ailsa J. McKay
Laura H. Gunn
Thirunavukkarasu Sathish
Eszter Vamos
Manjula Nugawela
Azeem Majeed
German Molina
Sobha Sivaprasad
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Diabetic Retinopathy
Care
Diabetic Retinopathy
Type 2 Diabetes
Published in: BMC Medicine / Issue 1/2021
Electronic ISSN: 1741-7015
DOI: https://doi.org/10.1186/s12916-021-01966-x

At a glance: The STEP trials

Springer Medicine

Associations between attainment of incentivised primary care indicators and incident diabetic retinopathy in England: a population-based historical cohort study

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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