title: Treatment quality indicators predict short-term outcomes in patients with diabetes: a prospective cohort study using the GIANTT database.
abstract: OBJECTIVE
  To assess whether quality indicators for treatment of cardiovascular and renal risk factors are associated with short-term outcomes in patients with diabetes.
  
  
  METHODS
  A prospective cohort study using linear regression adjusting for confounders.
  
  
  METHODS
  The GIANTT database (Groningen Initiative to Analyse Type 2 Diabetes Treatment) containing data from primary care medical records from The Netherlands.
  
  
  METHODS
  15 453 patients with type 2 diabetes mellitus diagnosed before 1 January 2008. Mean age 66.5 years, 47.5% men.
  
  
  METHODS
  Quality indicators assessing current treatment (CT) status or treatment intensification (TI) for patients with diabetes with elevated cardiovascular or renal risk factors.
  
  
  METHODS
  Low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), and albumin:creatinine ratio (ACR) before and after assessment of treatment quality.
  
  
  RESULTS
  Use of lipid-lowering drugs was associated with better LDL-C levels (-0.41 mmol/litre; 95% CI -0.48 to -0.34). Use of blood pressure-lowering drugs and use of renin-angiotensin system inhibitors in patients with elevated risk factor levels was not associated with better SBP and ACR outcomes, respectively. TI was also associated with better LDL-C (-0.82 mmol/litre; CI -0.93 to -0.71) in patients with elevated LDL-C levels, and with better SBP (-1.26 mm Hg; CI -2.28 to -0.24) in patients with two elevated SBP levels. Intensification of albuminuria-lowering treatment showed a tendency towards better ACR (-2.47 mmol/mg; CI -5.32 to 0.39) in patients with elevated ACR levels.
  
  
  CONCLUSIONS
  Quality indicators of TI were predictive of better short-term cardiovascular and renal outcomes, whereas indicators assessing CT status showed association only with better LDL-C outcome.
authors: Department of Clinical Pharmacology, University Medical Center Groningen, The Netherlands.
authors: Grigory
authors: G
authors: Sidorenkov
authors: Jaco
authors: J
authors: Voorham
authors: Dick
authors: D
authors: de Zeeuw
authors: Flora M
authors: FM
authors: Haaijer-Ruskamp
authors: Petra
authors: P
authors: Denig
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007674:Kidney Diseases / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D009426:Netherlands; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012084:Renin-Angiotensin System / Q000502:physiology; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D000960:Hypolipidemic Agents