title: Family practices' achievement of diabetes quality of care targets and risk of screen-detected diabetic retinopathy.
abstract: BACKGROUND
  We aimed to determine whether family practices' achievement of diabetes quality of care targets is associated with diabetic retinal disease in registered patients.
  
  
  METHODS
  Data for achievement of diabetes quality of care targets, including the proportion of patients with HbA1c < or = 7.5%, for 144 family practices in London UK, for the years 2004/5 to 2007/8, were linked to data from a population-based diabetes eye screening programme collected from September 2007 to February 2009. Analyses were adjusted for age, sex, duration and type of diabetes, unadjusted diabetes prevalence, ethnicity and deprivation category.
  
  
  RESULTS
  Data were analysed for 24,458 participants with one or more eye screening results in the period. There were 9,332 (38%) with any diabetic retinopathy and 2,819 (11.5%) with sight threatening diabetic retinopathy (STDR), including 2,654 (10.9%) with maculopathy. Among participants registered at 13 family practices that were in the highest quartile for achievement of the HbA1c quality of care target for all four years of study, the relative odds of any diabetic retinopathy were 0.78 (0.69 to 0.88) P<0.001. For participants at 12 practices consistently in the lowest quartile of HbA1c achievement, the relative odds of any diabetic retinopathy were 1.16 (1.03 to 1.30), P = 0.015. In the highest achieving practices, the relative odds of maculopathy were 0.74 (0.62 to 0.89), P = 0.001 and STDR 0.77 (0.65 to 0.92), P = 0.004.
  
  
  CONCLUSIONS
  The risk of diabetic retinopathy might be lower at family practices that consistently achieve highly on diabetes quality of care targets for HbA1c.
authors.affiliation: Division of Health and Social Care Research, King's College London, London, United Kingdom. martin.gulliford@kcl.ac.uk
authors.forename: Martin C
authors.initials: MC
authors.lastname: Gulliford
authors.forename: Hiten
authors.initials: H
authors.lastname: Dodhia
authors.forename: Sobha
authors.initials: S
authors.lastname: Sivaprasad
authors.forename: Mark
authors.initials: M
authors.lastname: Ashworth
mesh_terms: D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000628:therapy; D006442:Glycated Hemoglobin; D006801:Humans; D008131:London; D008268:Macular Degeneration; D010818:Practice Patterns, Physicians'; D011787:Quality of Health Care
chemical_list: D006442:Glycated Hemoglobin
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