Nøkleby Kjersti, Berg Tore J, Mdala Ibrahimu, Buhl Esben S, Claudi Tor, Cooper John G, Løvaas Karianne F, Sandberg Sverre, Jenum Anne K
Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Diabet Med. 2021 Aug;38(8):e14586. doi: 10.1111/dme.14586. Epub 2021 May 7.
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.
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 (HbA >69 mmol/mol (>8.5%)) as outcome variables.
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.
We found a pattern of lower CVD risk and better glycaemic control in patients of GPs performing more recommended diabetes processes of care.
探讨全科医生（GP）对推荐的护理流程的执行情况是否与2型糖尿病患者的心血管疾病（CVD）估计风险及血糖控制不佳相关。
一项来自挪威全科医疗的横断面研究，纳入6015名年龄<75岁、无CVD的2型糖尿病患者及其275名全科医生。根据每位全科医生对六项推荐护理流程的平均执行情况，将全科医生分为五个五分位数组。在多水平回归模型中，五分位数组为暴露变量，以NORRISK 2估计的10年心血管事件风险（总和可改变部分）及血糖控制不佳（糖化血红蛋白>69 mmol/mol（>8.5%））作为结局变量。
10年CVD风险的总和及可改变部分的平均估计值分别为12.3%和3.3%。与表现最佳的五分位数组中的全科医生的患者相比，表现最差的五分位数组中的全科医生所治疗的患者，其调整后的CVD总风险和可改变风险分别高出1.88（95%可信区间1.17 - 2.60）和1.78（1.14 - 2.41）个百分点。这意味着，与表现最佳的五分位数组相比，表现最差的五分位数组中的全科医生的患者，其CVD总风险相对平均高出16.6%，可改变风险高出74.8%。对于表现最差的五分位数组中的全科医生的患者，血糖控制不佳的调整后比值比是表现最佳的五分位数组中的全科医生的患者的1.77（1.27 - 2.46）倍。
我们发现，执行更多推荐糖尿病护理流程的全科医生的患者，其CVD风险较低，血糖控制较好。
