Associations between attainment of incentivized primary care indicators and incident sight‐threatening diabetic retinopathy in England: A population‐based historical cohort study

Abstract

Aims To examine the impact of attainment of primary care diabetes clinical indicators on the progression to sight threatening diabetic retinopathy (STDR) among those with mild non‐proliferative diabetic retinopathy (NPDR). Materials and methods A historical cohort study of 18,978 adults (43.63% female) diagnosed with type 2 diabetes before 1 April 2010 and mild NPDR before 1 April 2011. The data were obtained from the UK Clinical Practice Research Datalink between 2010‐2017, and provided by 330 primary care practices in England. Exposures included attainment of the Quality and Outcomes Framework HbA1c (≤59 mmol/mol (≤7.5%)), blood pressure (≤140/80 mmHg) and cholesterol (≤5 mmol/L) indicators in financial year 2010‐11, and number of National Diabetes Audit processes completed in 2010‐11. The outcome was time to incident STDR. Nearest neighbour propensity score matching was undertaken and univariable and multivariable Cox proportional hazards models then fitted using the matched samples. Concordance statistics were calculated for each model. Results A total of 1,037 (5.5%) STDR diagnoses were observed over a mean follow‐up of 3.6 (SD 2.0) years. HbA1c, blood pressure, and cholesterol indicator attainment were associated with lower rates of STDR (adjusted hazard ratios (95% CI) 0.64 (0.55‐0.74; p<0.001), 0.83 (0.72‐0.94; p=0.005), and 0.80 (0.66‐0.96; p=0.015), respectively). Conclusions Our findings provide support for meeting appropriate indicators for the management of type 2 diabetes in primary care to bring a range of benefits, including improved health outcomes – such as a reduction in the risk of STDR – for people with type 2 diabetes.