Long-term quality-of-care score predicts incident chronic kidney disease in patients with type 2 diabetes. Issue 11 (15th February 2018) - Li, Pi-I
Abstract: Background: Chronic kidney disease (CKD) is a common complication of diabetes, and requires long-term medical care. However, besides the blood glucose level, no reliable method is currently available to link the quality of care and the development of CKD. We therefore developed a long-term quality-of-care score for predicting the occurrence of CKD in patients with type 2 diabetes. Methods: In this retrospective cohort study, using Taiwan's Longitudinal Cohort of Diabetes Patients Database and the medical records in a medical center, we identified incident patients with type 2 diabetes during 1999–2003 and followed them until 2011. A quality-of-care score (from 0 to 8) was calculated according to process indicators (frequencies of HbA1c and lipid profile testing and urine, foot, and retinal examinations), intermediate outcome indicators (low-density lipoprotein, blood pressure, and HbA1c) and comorbidity of hypertension. We used Cox regression models to evaluate the association between the score and the incidence of CKD. Results: Of the 4754 patients enrolled, 1407 developed CKD after a mean follow-up of 9.06 years. Compared with the risk of developing a CKD event in patients with scores ≤2, the risk was 69% lower in those with quality-of-care scores ≥5 (hazard ratio [HR] 0.31; 95% confidence interval [CI] 0.25–0.40) and 33% lower in those with scores between 3 and 4 (HR 0.67; 95% CI 0.59–0.77). Conclusions: Good quality of care can reduce the risk of CKD in patients with type 2 diabetes. The score developed in this study had a significant association with the risk of CKD and thus can be applied to guide the care for these patients.