The variability over time of different clinical parameters, such as blood sugar, blood pressure, uric acid and lipid values, is directly associated with an increased risk of complications in people with type 2 diabetes.

The reasons for the link between variability and risk of complications are not yet fully understood; however, a sub-optimal quality of care could play a role in determining these fluctuations.

Diabetes Care, one of the most prestigious specialized journals in the field, has recently published the results of a new study carried out by a group of Italian clinicians and epidemiologists in the framework of research activities related to the Annals of AMD, Association of Diabetologists.

In this study, the relationship between the quality of care provided by diabetes centres and the intra-individual variability of a series of clinical parameters was evaluated.
The quality of care was indicated by Q-score, a widely validated summary measure. The study examined a sample of 273,888 subjects followed by 300 Italian diabetes centres, for which it was clearly found that low Q-scores, i.e. less appropriate treatments, were associated with an increase in the variability of the clinical parameters examined (HbA1c, blood pressure, total cholesterol and LDL, uric acid).

In terms of implications for clinical practice, these results suggest that the variability in clinical parameters can result from poor quality of care or poor compliance of the patient with the therapies adopted: every effort is therefore directed to maintain the clinical parameters in the range of values recommended by the guidelines with timely intensification of therapeutic regimens, when necessary.

Finally, the study shows how therapeutic intervention should be aimed not only at glycemic control but also at the control of other clinical parameters equally important in determining the complications of diabetes.

References

Overall Quality of Care Predicts the Variability of Key Risk Factors for Complications in Type 2 Diabetes: An Observational, Longitudinal Retrospective Study

Antonio Ceriello, Maria Chiara Rossi, Salvatore De Cosmo, Giuseppe Lucisano, Roberto Pontremoli, Paola Fioretto, Carlo Giorda, Antonio Pacilli, Francesca Viazzi, Giuseppina Russo, and Antonio Nicolucci, on behalf of the AMD-Annals Study Group.

Diabetes Care 2019 Feb; dc181471. https://doi.org/10.2337/dc18-1471