Increased mortality risk in people who do not receive all NICE-recommended care processes

This retrospective cohort study sought to assess whether completion of the nine annual NICE-recommended care processes was associated with mortality over the subsequent decade of follow-up, taking into account the levels of the parameters measured. The study population included all participants in the 2009/2010 National Diabetes Audit who were aged 17–99 years. Individuals were followed up until death or 31 December 2019.

Data on 179 105 people with type 1 diabetes and 1 397 790 with type 2 diabetes were analysed. Results in those with type 1 diabetes are summarised here. Overall, 45.0% received all eight care processes (retinal examinations were not evaluated due to unreliability of the data), while 34.2% received 6–7 processes and 20.8% received ≤5 processes. Lower age, non-white ethnicity and higher HbA_1c were associated with lower likelihood of receiving all eight processes.

The all-cause age- and sex-standardised mortality rates (per 1000 person-years) were 33.5, 34.4 and 30.7 in those who received ≤5, 6–7 and 8 care processes, respectively. After adjustment for age, sex, ethnicity, diabetes duration and socioeconomic deprivation, as well as smoking, HbA_1c, blood pressure, cholesterol and BMI, the risk of all-cause mortality was 38% greater (hazard ratio, 1.38; 95% confidence interval, 1.29–1.47) in those who received ≤5 care processes compared with those who received all eight.

The associations between care process completion and mortality were consistent between those with type 1 and type 2 diabetes, and were independent of whether care was routinely received in the primary or secondary setting. Regarding the individual care processes, measurement of BMI, HbA_1c and cholesterol had the greatest effect on mortality risk.

The authors conclude that people with diabetes have a higher mortality risk if their records of routine care indicate several missing annual care processes. Individuals who are missing these care processes represent an at-risk group, and efforts to specifically engage them, as well as to minimise barriers to completing the care processes, would likely yield positive results.

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