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Exploring HbA1c variation between Australian diabetes centres: The impact of centre-level and patient-level factors

BACKGROUND: Increasing global diabetes incidence has profound implications for health systems and for people living with diabetes. Guidelines have established clinical targets but there may be variation in clinical outcomes including HbA1c, based on location and practice size. Investigating this var...

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Autores principales: Quigley, Matthew, Earnest, Arul, Szwarcbard, Naomi, Wischer, Natalie, Andrikopoulos, Sofianos, Green, Sally, Zoungas, Sophia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8815864/
https://www.ncbi.nlm.nih.gov/pubmed/35120182
http://dx.doi.org/10.1371/journal.pone.0263511
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author Quigley, Matthew
Earnest, Arul
Szwarcbard, Naomi
Wischer, Natalie
Andrikopoulos, Sofianos
Green, Sally
Zoungas, Sophia
author_facet Quigley, Matthew
Earnest, Arul
Szwarcbard, Naomi
Wischer, Natalie
Andrikopoulos, Sofianos
Green, Sally
Zoungas, Sophia
author_sort Quigley, Matthew
collection PubMed
description BACKGROUND: Increasing global diabetes incidence has profound implications for health systems and for people living with diabetes. Guidelines have established clinical targets but there may be variation in clinical outcomes including HbA1c, based on location and practice size. Investigating this variation may help identify factors amenable to systemic improvement interventions. The aims of this study were to identify centre-specific and patient-specific factors associated with variation in HbA1c levels and to determine how these associations contribute to variation in performance across diabetes centres. METHODS: This cross-sectional study analysed data for 5,872 people with type 1 (n = 1,729) or type 2 (n = 4,143) diabetes mellitus collected through the Australian National Diabetes Audit (ANDA). A linear mixed-effects model examined centre-level and patient-level factors associated with variation in HbA1c levels. RESULTS: Mean age was: 43±17 years (type 1), 64±13 (type 2); median disease duration: 18 years (10,29) (type 1), 12 years (6,20) (type 2); female: 52% (type 1), 45% (type 2). For people with type 1 diabetes, volume of patients was associated with increases in HbA1c (p = 0.019). For people with type 2 diabetes, type of centre was associated with reduction in HbA1c (p <0.001), but location and patient volume were not. Associated patient-level factors associated with increases in HbA1c included past hyperglycaemic emergencies (type 1 and type 2, p<0.001) and Aboriginal and Torres Strait Islander status (type 2, p<0.001). Being a non-smoker was associated with reductions in HbA1c (type 1 and type 2, p<0.001). CONCLUSIONS: Centre-level and patient-level factors were associated with variation in HbA1c, but patient-level factors had greater impact. Interventions targeting patient-level factors conducted at a centre level including sick-day management, smoking cessation programs and culturally appropriate diabetes education for and Aboriginal and Torres Strait Islander peoples may be more important for improving glycaemic control than targeting factors related to the Centre itself.
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spelling pubmed-88158642022-02-05 Exploring HbA1c variation between Australian diabetes centres: The impact of centre-level and patient-level factors Quigley, Matthew Earnest, Arul Szwarcbard, Naomi Wischer, Natalie Andrikopoulos, Sofianos Green, Sally Zoungas, Sophia PLoS One Research Article BACKGROUND: Increasing global diabetes incidence has profound implications for health systems and for people living with diabetes. Guidelines have established clinical targets but there may be variation in clinical outcomes including HbA1c, based on location and practice size. Investigating this variation may help identify factors amenable to systemic improvement interventions. The aims of this study were to identify centre-specific and patient-specific factors associated with variation in HbA1c levels and to determine how these associations contribute to variation in performance across diabetes centres. METHODS: This cross-sectional study analysed data for 5,872 people with type 1 (n = 1,729) or type 2 (n = 4,143) diabetes mellitus collected through the Australian National Diabetes Audit (ANDA). A linear mixed-effects model examined centre-level and patient-level factors associated with variation in HbA1c levels. RESULTS: Mean age was: 43±17 years (type 1), 64±13 (type 2); median disease duration: 18 years (10,29) (type 1), 12 years (6,20) (type 2); female: 52% (type 1), 45% (type 2). For people with type 1 diabetes, volume of patients was associated with increases in HbA1c (p = 0.019). For people with type 2 diabetes, type of centre was associated with reduction in HbA1c (p <0.001), but location and patient volume were not. Associated patient-level factors associated with increases in HbA1c included past hyperglycaemic emergencies (type 1 and type 2, p<0.001) and Aboriginal and Torres Strait Islander status (type 2, p<0.001). Being a non-smoker was associated with reductions in HbA1c (type 1 and type 2, p<0.001). CONCLUSIONS: Centre-level and patient-level factors were associated with variation in HbA1c, but patient-level factors had greater impact. Interventions targeting patient-level factors conducted at a centre level including sick-day management, smoking cessation programs and culturally appropriate diabetes education for and Aboriginal and Torres Strait Islander peoples may be more important for improving glycaemic control than targeting factors related to the Centre itself. Public Library of Science 2022-02-04 /pmc/articles/PMC8815864/ /pubmed/35120182 http://dx.doi.org/10.1371/journal.pone.0263511 Text en © 2022 Quigley et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Quigley, Matthew
Earnest, Arul
Szwarcbard, Naomi
Wischer, Natalie
Andrikopoulos, Sofianos
Green, Sally
Zoungas, Sophia
Exploring HbA1c variation between Australian diabetes centres: The impact of centre-level and patient-level factors
title Exploring HbA1c variation between Australian diabetes centres: The impact of centre-level and patient-level factors
title_full Exploring HbA1c variation between Australian diabetes centres: The impact of centre-level and patient-level factors
title_fullStr Exploring HbA1c variation between Australian diabetes centres: The impact of centre-level and patient-level factors
title_full_unstemmed Exploring HbA1c variation between Australian diabetes centres: The impact of centre-level and patient-level factors
title_short Exploring HbA1c variation between Australian diabetes centres: The impact of centre-level and patient-level factors
title_sort exploring hba1c variation between australian diabetes centres: the impact of centre-level and patient-level factors
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8815864/
https://www.ncbi.nlm.nih.gov/pubmed/35120182
http://dx.doi.org/10.1371/journal.pone.0263511
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