scholarly journals Factors associated with choice of intensification treatment for type 2 diabetes after metformin monotherapy: a cohort study in UK primary care

2018 ◽  
Vol Volume 10 ◽  
pp. 1639-1648 ◽  
Author(s):  
Samantha Wilkinson ◽  
Ian J Douglas ◽  
Elizabeth Williamson ◽  
Heide Stirnadel-Farrant ◽  
Damian Fogarty ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Cohort Study ◽  
Factors Associated ◽  
Metformin Monotherapy

scholarly journals Is there an association between serum 25(OH)D3 and mental well-being in patients with type 2 diabetes? Results from a cohort study in primary care

HORMONES ◽  
2020 ◽  
Vol 19 (3) ◽  
pp. 361-367
Author(s):  
Maria Samefors ◽  
Robert Scragg ◽  
Fredrik H. Nystrom ◽  
Carl Johan Östgren
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Cohort Study ◽  
Well Being ◽  
Mental Well Being

scholarly journals Associations between attainment of incentivized primary care indicators and incident lower limb amputation among those with type 2 diabetes: a population-based historical cohort study

2021 ◽  
Vol 9 (1) ◽  
pp. e002069
Author(s):  
Laura H Gunn ◽  
Eszter P Vamos ◽  
Azeem Majeed ◽  
Pasha Normahani ◽  
Usman Jaffer ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Primary Care ◽  
Cohort Study ◽  
Lower Limb ◽  
Population Based ◽  
Lower Limb Amputation ◽  
Medical Decision ◽  
Limb Amputation

IntroductionEngland has invested considerably in diabetes care through such programs as the Quality and Outcomes Framework (QOF) and National Diabetes Audit (NDA). Associations between program indicators and clinical endpoints, such as amputation, remain unclear. We examined associations between primary care indicators and incident lower limb amputation.Research design and methodsThis population-based retrospective cohort study, spanning 2010–2017, was comprised of adults in England with type 2 diabetes and no history of lower limb amputation. Exposures at baseline (2010–2011) were attainment of QOF glycated hemoglobin (HbA1c), blood pressure and total cholesterol indicators, and number of NDA processes completed. Propensity score matching was performed and multivariable Cox proportional hazards models, adjusting for disease-related, comorbidity, lifestyle, and sociodemographic factors, were fitted using matched samples for each exposure.Results83 688 individuals from 330 English primary care practices were included. Mean follow-up was 3.9 (SD 2.0) years, and 521 (0.6%) minor or major amputations were observed (1.62 per 1000 person-years). HbA1c and cholesterol indicator attainment were associated with considerably lower risks of minor or major amputation (adjusted HRs; 95% CIs) 0.61 (0.49 to 0.74; p<0.0001) and 0.67 (0.53 to 0.86; p=0.0017), respectively). No evidence of association between blood pressure indicator attainment and amputation was observed (adjusted HR 0.88 (0.73 to 1.06; p=0.1891)). Substantially lower amputation rates were observed among those completing a greater number of NDA care processes (adjusted HRs 0.45 (0.24 to 0.83; p=0.0106), 0.67 (0.47 to 0.97; p=0.0319), and 0.38 (0.20 to 0.70; p=0.0022) for comparisons of 4–6 vs 0–3, 7–9 vs 0–3, and 7–9 vs 4–6 processes, respectively). Results for major-only amputations were similar for HbA1c and blood pressure, though cholesterol indicator attainment was non-significant.ConclusionsComprehensive primary care-based secondary prevention may offer considerable protection against diabetes-related amputation. This has important implications for diabetes management and medical decision-making for patients, as well as type 2 diabetes quality improvement programs.

scholarly journals On the survival of individuals diagnosed with type 2 diabetes mellitus in the United Kingdom: a retrospective matched cohort study

2021 ◽  
Author(s):  
Njabulo Ncube ◽  
Elena Kulinskaya ◽  
Nicholas Steel ◽  
Dmitry Pchejetski
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Primary Care ◽  
Type 2 Diabetes Mellitus ◽  
Cohort Study ◽  
Birth Cohort ◽  
Matched Cohort ◽  
Birth Cohorts ◽  
All Cause Mortality

Objective To estimate long-term hazards of all-cause mortality following a diagnosis of type 2 diabetes mellitus (T2DM) using electronic primary care data. Methodology Retrospective matched cohort study using electronic health records from THIN primary care database. The study included individuals born between 1930 and 1960, diagnosed with T2DM between 2000 and 2016 and aged 50-74 years and excluded those with pre-existing stroke, cancer, cognitive impairment, lower limb amputation or chronic kidney disease (CKD) stages 3 to 5. T2DM individuals were matched at diagnosis to at most 3 controls by age, gender and general practice (GP) and followed up to 1 January 2017. Time-varying hazards of all-cause mortality were then estimated using Gompertz-double-Cox model with frailty on GP, adjusting for medical history, socio-demographic and lifestyle factors. Results A total of 221 182 (57.6% Males, 30.8% T2DM) individuals were selected for the study of whom 29 618 (13.4%) died during follow-up. The adjusted mortality hazard of type 2 diabetes mellitus (T2DM) was estimated to be 1.21[1.12-1.3] and 1.52[1.44-1.6] among individuals diagnosed at 50-59 years and 60-74 years, respectively, compared to controls. Deprivation, obesity, smoking and comorbidities affected survival of cases and controls equally. Compared to the 1930-39 birth cohort, all-cause mortality hazards were reduced in the 1940-49 cohort, but increased at older ages in the 1950-60 birth cohort for both cases and controls. Conclusion T2DM is associated with raised all-cause mortality hazards which increase with age of diagnosis. These hazards associated with age at diagnosis are constant across all birth cohorts demonstrating a lack of progress over time in reducing the relative risks of all-cause mortality associated with T2DM. A further study that includes people born after 1960 is needed to fully understand the emerging higher mortality hazards among the younger birth cohorts.

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