Health outcomes in diabetics measured with Minnesota Community Measurement quality metrics

Figures & data

Table 1 Characteristics of 5,731 diabetics in 2009, overall, and by optimal control statusa

Characteristic	Population 7,050 n=5,731 (81.3%)	Non-optimal control n=2,889	Optimal control n=2,842	P-valueb
Age (years), mean (SD)	64.5 (13.9)	62.6 (14.5)	66.4 (13.0)	<0.001
Age (years)				<0.001
<75	4,311 (75.2)	2,266 (78.4)	2,045 (72.0)
≥75	1,420 (24.8)	623 (21.6)	797 (28.0)
Sex				<0.001
Women	2,623 (45.8)	1,424 (49.3)	1,199 (42.2)
Men	3,108 (54.2)	1,465 (50.7)	1,643 (57.8)
Charlson index, mean (SD)	4.5 (3.2)	4.4 (3.2)	4.6 (3.2)	0.002
Diabetic control measures, median (IQR)
LDL cholesterol (mg/mL)	84 (68, 102)	102 (77, 119)	76 (64, 87)	<0.001
SBP (mmHg)	124 (114, 134)	129 (118, 144)	120 (112, 128)	<0.001
DBP (mmHg)	70 (62, 77)	72 (65, 80)	68 (60, 74)	<0.001
Hemoglobin A1c (%)	6.9 (6.3, 7.7)	7.3 (6.4, 8.4)	6.7 (6.2, 7.2)	<0.001
Diabetic control measures
LDL cholesterol <100 mg/mL	4,168 (72.7)	1,326 (45.9)	2,842 (100.0)	<0.001
BP <140/90 mm/Hg	4,645 (81.1)	1,803 (62.4)	2,842 (100.0)	<0.001
Hemoglobin A1c <8%	4,623 (80.7)	1,781 (61.6)	2,842 (100.0)	<0.001
No of measures under control				<0.001
0	100 (1.7)	100 (3.5)	0 (0.0)
1	668 (11.7)	668 (23.1)	0 (0.0)
2	2,121 (37.0)	2,121 (73.4)	0 (0.0)
3	2,842 (49.6)	0 (0.0)	2,842 (100.0)
ED visit	2,240 (39.1)	1,187 (41.1)	1,053 (37.1)	0.002
ED visits				0.002
0	3,491 (60.9)	1,702 (58.9)	1,789 (62.9)
1–2	1,638 (28.6)	851 (29.5)	787 (27.7)
≥3	602 (10.5)	336 (11.6)	266 (9.4)
Hospitalization	1,529 (26.7)	790 (27.3)	739 (26.0)	0.25
No of hospitalizations				0.45
0	4,202 (73.3)	2,099 (72.7)	2,103 (74.0)
1	867 (15.1)	453 (15.7)	414 (14.6)
≥2	662 (11.6)	337 (11.7)	325 (11.4)
30-day rehospitalizationc	211 (13.8)	109 (13.8)	102 (13.8)	0.99
ICU stay	403 (7.0)	215 (7.4)	188 (6.6)	0.22
No of ICU stays				0.09
0	5,328 (93.0)	2,674 (92.6)	2,654 (93.4)
1–2	366 (6.4)	190 (6.6)	176 (6.2)
≥3	37 (0.6)	25 (0.9)	12 (0.4)
Mortality	540 (9.4)	275 (9.5)	265 (9.3)	0.80

Notes: Data are presented as n (%) unless otherwise indicated.

a Optimal control includes presence of all three measures at baseline: LDL cholesterol <100 mg/mL, hemoglobin A_1c <8%, and blood pressure <140/90 mm/Hg

b P value from chi-square (categorical variables) or Wilcoxon rank-sum (continuous variables) tests

c defined as a rehospitalization within 30 days following the first hospitalization that occurs after 9/1/2009; limited to those who had at least one hospitalization.

Abbreviations: BP, blood pressure; DBP, diastolic blood pressure; ED, emergency department; ICU, intensive care unit; IQR, interquartile range; LDL, low-density lipoprotein; SBP, systolic blood pressure; SD, standard deviation.

Table 2 Risk of health outcomesa among patients with non-optimal control of diabetes mellitus compared with patients with optimal control (referent)

Outcome	Unadjusted		Adjustedb
	HR (95% CI)	P-value	HR (95% CI)	P-value
ED visit	1.16 (1.07–1.26)	<0.001	1.15 (1.06–1.25)	<0.001
Hospitalization	1.07 (0.97–1.18)	0.18	1.11 (1.00–1.23)	0.04
30-day rehospitalizationc	1.02 (0.78–1.34)	0.88	1.03 (0.78–1.36)	0.83
ICU stay	1.13 (0.93–1.38)	0.21	1.19 (0.97–1.45)	0.09
Mortality	1.05 (0.89–1.25)	0.55	1.29 (1.09–1.53)	0.003

Notes:

a Risk was estimated from Cox proportional hazard models comparing those with non-optimal control with those with optimal control (referent group)

b adjusted for age, sex, and Charlson index

c defined as a rehospitalization within 30 days following the first hospitalization that occurs after 9/1/2009; limited to those who had at least one hospitalization.

Abbreviations: CI, confidence interval; ED, emergency department; HR, hazard ratio; ICU, intensive care unit.

Table 3 Adjusteda risk of health outcomes among men and women with non-optimal control of diabetes mellitus compared with patients with optimal control (referent)

Outcome	Men			Women
	No (%)	HR (95% CI)	P-value	No (%)	HR (95% CI)	P-value
ED visit	1,160 (37.3)	1.16 (1.03–1.30)	0.01	1,080 (41.2)	1.15 (1.02–1.29)	0.03
Hospitalization	836 (26.9)	1.13 (0.99–1.30)	0.08	693 (26.4)	1.09 (0.94–1.27)	0.25
30-day rehospitalizationb	127 (15.2)	1.06 (0.74–1.51)	0.75	84 (12.1)	0.97 (0.63–1.50)	0.90
ICU stay	232 (7.5)	1.29 (0.99–1.67)	0.06	171 (6.5)	1.08 (0.79–1.46)	0.64
Mortality	320 (10.3)	1.34 (1.07–1.67)	0.01	220 (8.4)	1.18 (0.91–1.54)	0.22

Notes:

a Adjusted for age and Charlson index. Risk was estimated from Cox proportional hazard models comparing those with non-optimal control with those with optimal control (referent group)

b defined as a rehospitalization within 30 days following the first hospitalization that occurs after 9/1/2009; limited to those who had at least one hospitalization.

Abbreviations: CI, confidence interval; ED, emergency department; HR, hazard ratio; ICU, intensive care unit.

Table 4 Adjusteda risk of health outcomes among patients with different control levels of diabetes mellitus compared with patients with optimal control (referent)

No of factors under control	ED visit	Hospitalization	30-day rehospitalizationb	ICU stay	Mortality
3	Reference	Reference	Reference	Reference	Reference
2	1.08 (0.99–1.19)	1.06 (0.95–1.18)	0.99 (0.73–1.34)	1.11 (0.89–1.38)	1.15 (0.95–1.39)
1	1.37 (1.21–1.56)	1.26 (1.07–1.47)	1.11 (0.74–1.68)	1.29 (0.95–1.75)	1.85 (1.43–2.38)
0	1.37 (1.02–1.83)	1.33 (0.93–1.90)	1.31 (0.53–3.23)	2.47 (1.43–4.28)	1.32 (0.62–2.81)
P-valuec	<0.001	0.004	0.57	0.007	<0.001

Notes: Data are presented as HR (95% CI) unless otherwise indicated.

a Adjusted for age, sex, and Charlson index. Risk was estimated from Cox proportional hazard models comparing those with non-optimal control with those with optimal control (referent group)

b defined as a rehospitalization within 30 days following the first hospitalization that occurs after 9/1/2009; limited to those who had at least one hospitalization

c P value for chi-square test for trend.

Abbreviations: CI, confidence interval; ED, emergency department; HR, hazard ratio; ICU, intensive care unit.