Despite the heightened awareness of diabetes as a major health problem, evidence on the impact of assistance and\r\norganizational factors, as well as of adherence to recommended care guidelines, on morbidity and mortality in diabetes is\r\nscanty. We identified diabetic residents in Torino, Italy, as of 1st January 2002, using multiple independent data sources. We\r\ncollected data on several laboratory tests and specialist medical examinations to compare primary versus specialty care\r\nmanagement of diabetes and the fulfillment of a quality-of-care indicator based on existing screening guidelines (GCI).\r\nThen, we performed regression analyses to identify associations of these factors with mortality and cardiovascular morbidity\r\nover a 4 year- follow-up. Patients with the lowest degree of quality of care (i.e. only cared for by primary care and with no\r\nfulfillment of GCI) had worse RRs for all-cause (1.72 [95% CI 1.57ââ?¬â??1.89]), cardiovascular (1.74 [95% CI 1.50ââ?¬â??2.01]) and cancer\r\n(1.35 [95% CI 1.14ââ?¬â??1.61]) mortality, compared with those with the highest quality of care. They also showed increased RRs\r\nfor incidence of major cardiovascular events up to 2.03 (95% CI 1.26ââ?¬â??3.28) for lower extremity amputations. Receiving\r\nspecialist care itself increased survival, but was far more effective when combined with the fulfillment of GCI. Throughout\r\nthe whole set of analysis, implementation of guidelines emerged as a strong modifier of prognosis. We conclude that\r\nmanagement of diabetic patients with a pathway based on both primary and specialist care is associated with a favorable\r\nimpact on all-cause mortality and CV incidence, provided that guidelines are implemented
Loading....