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Variability in the Control of Type 2 Diabetes in Primary Care and Its Association with Hospital Admissions for Vascular Events. The APNA Study

Type 2 diabetes (T2D) is associated with increased cardiovascular morbidity, mortality, and hospital admissions. This study aimed to analyze how the differences in delivered care (variability of glycosylated hemoglobin (HbA1c) achieved targets) affect hospital admissions for cardiovascular events (C...

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Autores principales: Guillen-Aguinaga, Sara, Forga, Luis, Brugos-Larumbe, Antonio, Guillen-Grima, Francisco, Guillen-Aguinaga, Laura, Aguinaga-Ontoso, Ines
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8703537/
https://www.ncbi.nlm.nih.gov/pubmed/34945149
http://dx.doi.org/10.3390/jcm10245854
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author Guillen-Aguinaga, Sara
Forga, Luis
Brugos-Larumbe, Antonio
Guillen-Grima, Francisco
Guillen-Aguinaga, Laura
Aguinaga-Ontoso, Ines
author_facet Guillen-Aguinaga, Sara
Forga, Luis
Brugos-Larumbe, Antonio
Guillen-Grima, Francisco
Guillen-Aguinaga, Laura
Aguinaga-Ontoso, Ines
author_sort Guillen-Aguinaga, Sara
collection PubMed
description Type 2 diabetes (T2D) is associated with increased cardiovascular morbidity, mortality, and hospital admissions. This study aimed to analyze how the differences in delivered care (variability of glycosylated hemoglobin (HbA1c) achieved targets) affect hospital admissions for cardiovascular events (CVEs) in T2D patients. Methods: We analyzed the electronic records in primary care health centers at Navarra (Spain) and hospital admission for CVEs. We followed 26,435 patients with T2D from 2012 to 2016. The variables collected were age, sex, health center, general practitioner practice (GPP), and income. The clinical variables were diagnosis of T2D, weight, height, body mass index (BMI), blood pressure (BP), HbA1c, low-density lipoprotein cholesterol (LDL-C), smoking, and antecedents of CVEs. We calculated, in each GPP practice, the proportion of patients with HbA1c ≥ 9. A non-hierarchical K-means cluster analysis classified GPPs into two clusters according to the level of compliance with HbA1C ≥ 9% control indicators. We used logistic and Cox regressions. Results: T2D patients had a higher probability of admission for CVEs when they belonged to a GPP in the worst control cluster of HbA1C ≥ 9% (HR = 1.151; 95% CI, 1.032–1.284).
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spelling pubmed-87035372021-12-25 Variability in the Control of Type 2 Diabetes in Primary Care and Its Association with Hospital Admissions for Vascular Events. The APNA Study Guillen-Aguinaga, Sara Forga, Luis Brugos-Larumbe, Antonio Guillen-Grima, Francisco Guillen-Aguinaga, Laura Aguinaga-Ontoso, Ines J Clin Med Article Type 2 diabetes (T2D) is associated with increased cardiovascular morbidity, mortality, and hospital admissions. This study aimed to analyze how the differences in delivered care (variability of glycosylated hemoglobin (HbA1c) achieved targets) affect hospital admissions for cardiovascular events (CVEs) in T2D patients. Methods: We analyzed the electronic records in primary care health centers at Navarra (Spain) and hospital admission for CVEs. We followed 26,435 patients with T2D from 2012 to 2016. The variables collected were age, sex, health center, general practitioner practice (GPP), and income. The clinical variables were diagnosis of T2D, weight, height, body mass index (BMI), blood pressure (BP), HbA1c, low-density lipoprotein cholesterol (LDL-C), smoking, and antecedents of CVEs. We calculated, in each GPP practice, the proportion of patients with HbA1c ≥ 9. A non-hierarchical K-means cluster analysis classified GPPs into two clusters according to the level of compliance with HbA1C ≥ 9% control indicators. We used logistic and Cox regressions. Results: T2D patients had a higher probability of admission for CVEs when they belonged to a GPP in the worst control cluster of HbA1C ≥ 9% (HR = 1.151; 95% CI, 1.032–1.284). MDPI 2021-12-14 /pmc/articles/PMC8703537/ /pubmed/34945149 http://dx.doi.org/10.3390/jcm10245854 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Guillen-Aguinaga, Sara
Forga, Luis
Brugos-Larumbe, Antonio
Guillen-Grima, Francisco
Guillen-Aguinaga, Laura
Aguinaga-Ontoso, Ines
Variability in the Control of Type 2 Diabetes in Primary Care and Its Association with Hospital Admissions for Vascular Events. The APNA Study
title Variability in the Control of Type 2 Diabetes in Primary Care and Its Association with Hospital Admissions for Vascular Events. The APNA Study
title_full Variability in the Control of Type 2 Diabetes in Primary Care and Its Association with Hospital Admissions for Vascular Events. The APNA Study
title_fullStr Variability in the Control of Type 2 Diabetes in Primary Care and Its Association with Hospital Admissions for Vascular Events. The APNA Study
title_full_unstemmed Variability in the Control of Type 2 Diabetes in Primary Care and Its Association with Hospital Admissions for Vascular Events. The APNA Study
title_short Variability in the Control of Type 2 Diabetes in Primary Care and Its Association with Hospital Admissions for Vascular Events. The APNA Study
title_sort variability in the control of type 2 diabetes in primary care and its association with hospital admissions for vascular events. the apna study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8703537/
https://www.ncbi.nlm.nih.gov/pubmed/34945149
http://dx.doi.org/10.3390/jcm10245854
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