Outcomes and inequalities in diabetes from 2004/2005 to 2011/2012: English longitudinal study

Fleetcroft, Robert; Asaria, Miqdad; Ali, Shehzad; Cookson, Richard

doi:10.3399/bjgp16x688381

Cited by 14 publications

(13 citation statements)

References 15 publications

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“…We observed particularly large rises in risk-adjusted, emergency readmission rates in diabetes patients, which could have several possible explanations. For example, it could be linked to significant reductions in mortality from diabetes and rises in the number of socioeconomically deprived populations, 43 but has previously also been linked to side effects of diabetic drugs. 44…”

Section: Discussionmentioning

confidence: 99%

National trends in emergency readmission rates: a longitudinal analysis of administrative data for England between 2006 and 2016

et al. 2018

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ObjectiveTo assess trends in 30-day emergency readmission rates across England over one decade.DesignRetrospective study design.Setting150 non-specialist hospital trusts in England.Participants23 069 134 patients above 18 years of age who were readmitted following an initial admission (n=62 584 297) between April 2006 and February 2016.Primary and secondary outcomesWe examined emergency admissions that occurred within 30 days of discharge from hospital (‘emergency readmissions’) as a measure of healthcare quality. Presented are overall readmission rates, and disaggregated by the nature of the indexed admission, including whether it was elective or emergency, and by clinical health condition recorded. All rates were risk-adjusted for patient age, gender, ethnicity, socioeconomic status, comorbidities and length of stay.ResultsThe average risk-adjusted, 30-day readmission rate increased from 6.56% in 2006/2007 to 6.76% (P<0.01) in 2012/2013, followed by a small decrease to 6.64% (P<0.01) in 2015/2016. Emergency readmissions for patients discharged following elective procedures decreased by 0.13% (P<0.05), whereas those following emergency admission increased by 1.27% (P<0.001). Readmission rates for hip or knee replacements decreased (−1.29%; P<0.001); for acute myocardial infarction (−0.04%; P<0.49), stroke (+0.62%; P<0.05), chronic obstructive pulmonary disease (+0.41%; P<0.05) and heart failure (+0.15%; P<0.05) remained stable; and for pneumonia (+2.72%; P<0.001), diabetes (+7.09%; P<0.001), cholecystectomy (+1.86%; P<0.001) and hysterectomy (+2.54%; P<0.001) increased.ConclusionsOverall, emergency readmission rates in England remained relatively stable across the observation period, with trends of slight increases contained post 2012/2013. However, there were large variations in trends across clinical areas, with some experiencing marked increases in readmission rates. This highlights the need to better understand variations in outcomes across clinical subgroups to allow for targeted interventions that will ensure highest standards of care provided for all patients.

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Section: Discussionmentioning

confidence: 99%

National trends in emergency readmission rates: a longitudinal analysis of administrative data for England between 2006 and 2016

et al. 2018

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“…Although across the UK population as a whole, from 2004 to 2012, the National Health Service (NHS) was successful in improving the quality of diabetes healthcare, inequality remained unchanged [27].…”

Section: Introductionmentioning

confidence: 99%

“…Studies of diabetes disparity tend to report indicators as either (i) clinical outcomes [27] or surrogate clinical markers [5,12,27,31] or (ii) care processes [32], but seldom both [19,21,23,26]. The primary objective of this study was to identify whether there are differences in glycaemic control (HbA1c) across socioeconomic and/or ethnic groups in the UK.…”

Section: Introductionmentioning

confidence: 99%

Disparities in glycaemic control, monitoring, and treatment of type 2 diabetes in England: A retrospective cohort analysis

et al. 2019

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BackgroundDisparities in type 2 diabetes (T2D) care provision and clinical outcomes have been reported in the last 2 decades in the UK. Since then, a number of initiatives have attempted to address this imbalance. The aim was to evaluate contemporary data as to whether disparities exist in glycaemic control, monitoring, and prescribing in people with T2D.Methods and findingsA T2D cohort was identified from the Royal College of General Practitioners Research and Surveillance Centre dataset: a nationally representative sample of 164 primary care practices (general practices) across England. Diabetes healthcare provision and glucose-lowering medication use between 1 January 2012 and 31 December 2016 were studied. Healthcare provision included annual HbA1c, renal function (estimated glomerular filtration rate [eGFR]), blood pressure (BP), retinopathy, and neuropathy testing. Variables potentially associated with disparity outcomes were assessed using mixed effects logistic and linear regression, adjusted for age, sex, ethnicity, and socioeconomic status (SES) using the Index of Multiple Deprivation (IMD), and nested using random effects within general practices. Ethnicity was defined using the Office for National Statistics ethnicity categories: White, Mixed, Asian, Black, and Other (including Arab people and other groups not classified elsewhere). From the primary care adult population (n = 1,238,909), we identified a cohort of 84,452 (5.29%) adults with T2D. The mean age of people with T2D in the included cohort at 31 December 2016 was 68.7 ± 12.6 years; 21,656 (43.9%) were female. The mean body mass index was 30.7 ± SD 6.4 kg/m2. The most deprived groups (IMD quintiles 1 and 2) showed poorer HbA1c than the least deprived (IMD quintile 5). People of Black ethnicity had worse HbA1c than those of White ethnicity. Asian individuals were less likely than White individuals to be prescribed insulin (odds ratio [OR] 0.86, 95% CI 0.79–0.95; p < 0.01), sodium-glucose cotransporter-2 (SGLT2) inhibitors (OR 0.68, 95% CI 0.58–0.79; p < 0.001), and glucagon-like peptide-1 (GLP-1) agonists (OR 0.37, 95% CI 0.31–0.44; p < 0.001). Black individuals were less likely than White individuals to be prescribed SGLT2 inhibitors (OR 0.50, 95% CI 0.39–0.65; p < 0.001) and GLP-1 agonists (OR 0.45, 95% CI 0.35–0.57; p < 0.001). Individuals in IMD quintile 5 were more likely than those in the other IMD quintiles to have annual testing for HbA1c, BP, eGFR, retinopathy, and neuropathy. Black individuals were less likely than White individuals to have annual testing for HbA1c (OR 0.89, 95% CI 0.79–0.99; p = 0.04) and retinopathy (OR 0.82, 95% CI 0.70–0.96; p = 0.011). Asian individuals were more likely than White individuals to have monitoring for HbA1c (OR 1.10, 95% CI 1.01–1.20; p = 0.023) and eGFR (OR 1.09, 95% CI 1.00–1.19; p = 0.048), but less likely for retinopathy (OR 0.88, 95% CI 0.79–0.97; p = 0.01) and neuropathy (OR 0.88, 95% CI 0.80–0.97; p = 0.01). The study is limited by the nature of being observational and defined using retrospect...

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“… 3 4 Large inequality gaps relating to social deprivation have been demonstrated in diabetes outcomes, with increased preventable hospitalisations for diabetes complications noted in more deprived communities. 5 Furthermore, the prevalence of T2D among ethnic minority groups is three to five times higher than the white European population. 6 The estimated prevalence of diabetes in London (9.1%) is higher than the national average (8.7%), 7 however data from the National Diabetes Audit in 2016/2017 demonstrated that only 41% of patients with T2D in London achieved all treatment targets recommended by the National Institute for Health and Clinical Excellence (NICE).…”

Section: Problemmentioning

confidence: 99%

Improving the management of type 2 diabetes through large-scale general practice: the role of a data-driven and technology-enabled education programme

et al. 2021

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A quality improvement (QI) scheme was launched in 2017, covering a large group of 25 general practices working with a deprived registered population. The aim was to improve the measurable quality of care in a population where type 2 diabetes (T2D) care had previously proved challenging. A complex set of QI interventions were co-designed by a team of primary care clinicians and educationalists and managers. These interventions included organisation-wide goal setting, using a data-driven approach, ensuring staff engagement, implementing an educational programme for pharmacists, facilitating web-based QI learning at-scale and using methods which ensured sustainability. This programme was used to optimise the management of T2D through improving the eight care processes and three treatment targets which form part of the annual national diabetes audit for patients with T2D. With the implemented improvement interventions, there was significant improvement in all care processes and all treatment targets for patients with diabetes. Achievement of all the eight care processes improved by 46.0% (p<0.001) while achievement of all three treatment targets improved by 13.5% (p<0.001). The QI programme provides an example of a data-driven large-scale multicomponent intervention delivered in primary care in ethnically diverse and socially deprived areas.

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Outcomes and inequalities in diabetes from 2004/2005 to 2011/2012: English longitudinal study

Cited by 14 publications

References 15 publications

National trends in emergency readmission rates: a longitudinal analysis of administrative data for England between 2006 and 2016

National trends in emergency readmission rates: a longitudinal analysis of administrative data for England between 2006 and 2016

Disparities in glycaemic control, monitoring, and treatment of type 2 diabetes in England: A retrospective cohort analysis

Improving the management of type 2 diabetes through large-scale general practice: the role of a data-driven and technology-enabled education programme

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