medwireNews: People with type 2 diabetes who are treated by a general practitioner (GP) with poor adherence to recommended follow-up procedures are at higher risk for cardiovascular disease (CVD) and poor blood sugar control than those who those registered with high-performing GPs are the ROSA 4 study.
The estimated mean 10-year CVD risk according to the NORRISK 2 score was 12.3% among the 6015 Norwegian participants (aged 18 to 75 years) without baseline CVD, while the modifiable CVD risk – calculated by omission of age, gender and ethnicity on the score – was 3.3%.
For the study, Kjersti Nøkleby (University of Oslo, Norway) and other authors calculated the average performance of the GP process from 0% to 100% based on the proportions of their patients with diabetes who received the following six treatment processes: Measurements of glycated hemoglobin ( HbA1c), low density lipoprotein cholesterol, albuminuria, and blood pressure; recorded foot examination in the last 15 months; and recorded eye exam over the past 30 months. The 275 general practitioners included in the study were divided into five quintiles based on their average performance in order to categorize them from best (quintile 5; n = 55) to worst (quintile 1; n = 54).
In a multivariate analysis, patients with general practitioners in quintile 1 (n = 1174) had an overall risk of CVD 1.88 percentage points higher than patients with general practitioners in quintile 5 (n = 1224), corresponding to a relative mean adjusted difference of 16.6 %.
The team also found that a general practitioner in quintile 1 was associated with a 1.78 percentage points higher modifiable risk of CVD than a general practitioner in quintile 5, with a relatively adjusted mean difference of 74.8% between the two groups. These results were consistent regardless of whether high-density lipoprotein cholesterol was included as a modifiable risk factor.
Patients with a general practitioner in quintile 1 were more likely to have HbA1c levels above 69 mmol / mol (8.5%) than patients with a general practitioner in quintile 5 with an adjusted odds ratio of 1.77.
“[Ο]Our findings that type 2 diabetes patients are at lower risk from general practitioners who perform high quality nursing processes are likely to be relevant / generalizable for other contexts and health systems, ”comment Nøkleby et al. in Diabetic Medicine.
“Quality improvement strategies adapted to the worst GPs are needed,” they say, concluding that “[f]Further studies with a longitudinal design are needed to investigate whether GP factors influence morbidity and mortality, preferably also with more detailed information on the patient’s comorbidities, socio-economic status and place of residence. “
medwireNews is an independent medical news service from Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group
Diabetes Med 2021; doi: 10.1111 / dme.14586
