Department of Primary Care and Public Health, Imperial College London, London, UK.
Department of Public Health Sciences and School of Data Science, University of North Carolina (UNC) at Charlotte, Charlotte, North Carolina, USA.
Diabetes Obes Metab. 2021 Jun;23(6):1322-1330. doi: 10.1111/dom.14344. Epub 2021 Mar 3.
To examine the impact of attainment of primary care diabetes clinical indicators on progression to sight-threatening diabetic retinopathy (STDR) among those with mild non-proliferative diabetic retinopathy (NPDR).
An historical cohort study of 18,978 adults (43.63% female) diagnosed with type 2 diabetes before 1 April 2010 and mild NPDR before 1 April 2011 was conducted. The data were obtained from the UK Clinical Practice Research Datalink during 2010-2017, provided by 330 primary care practices in England. Exposures included attainment of the Quality and Outcomes Framework HbA1c (≤59 mmol/mol [≤7.5%]), blood pressure (≤140/80 mmHg) and cholesterol (≤5 mmol/L) indicators in the financial year 2010-2011, as well as the number of National Diabetes Audit processes completed in 2010-2011. The outcome was time to incident STDR. Nearest neighbour propensity score matching was undertaken, and univariable and multivariable Cox proportional hazards models were then fitted using the matched samples. Concordance statistics were calculated for each model.
A total of 1037 (5.5%) STDR diagnoses were observed over a mean follow-up of 3.6 (SD 2.0) years. HbA1c, blood pressure and cholesterol indicator attainment were associated with lower rates of STDR (adjusted hazard ratios [95% CI] 0.64 [0.55-0.74; p < .001], 0.83 [0.72-0.94; p = .005] and 0.80 [0.66-0.96; p = .015], respectively).
Our findings provide support for meeting appropriate indicators for the management of type 2 diabetes in primary care to bring a range of benefits, including improved health outcomes-such as a reduction in the risk of STDR-for people with type 2 diabetes.
研究在患有轻度非增殖性糖尿病视网膜病变（NPDR）的患者中，达到初级保健糖尿病临床指标对向威胁视力的糖尿病性视网膜病变（STDR）进展的影响。
这是一项历史队列研究，纳入了 18978 名成年患者（43.63%为女性），他们在 2010 年 4 月 1 日之前被诊断为 2 型糖尿病，在 2011 年 4 月 1 日之前被诊断为轻度 NPDR。数据来自于 2010-2017 年期间英国临床实践研究数据链接，由英格兰 330 个初级保健实践提供。暴露因素包括在 2010-2011 财年达到质量和结果框架 HbA1c（≤59mmol/mol[≤7.5%]）、血压（≤140/80mmHg）和胆固醇（≤5mmol/L）指标，以及在 2010-2011 年完成的国家糖尿病审计过程数量。结果是出现新的 STDR 的时间。采用最近邻居倾向评分匹配，然后使用匹配样本拟合单变量和多变量 Cox 比例风险模型。为每个模型计算了一致性统计量。
在平均 3.6（标准差 2.0）年的随访中，共观察到 1037 例（5.5%）STDR 诊断。HbA1c、血压和胆固醇指标的达标与较低的 STDR 发生率相关（调整后的风险比[95%置信区间]分别为 0.64[0.55-0.74;p<0.001]、0.83[0.72-0.94;p=0.005]和 0.80[0.66-0.96;p=0.015]）。
我们的研究结果为初级保健中管理 2 型糖尿病达到适当指标提供了支持，这为 2 型糖尿病患者带来了一系列益处，包括改善健康结果，如降低 STDR 风险。
