Outpatient diabetes care quality matters after limb revascularisation

Jun 16 2014

By Eleanor McDermid, Senior medwireNews Reporter

High quality outpatient diabetes care improves diabetic patients’ chances of avoiding major ischaemic events and amputation after undergoing limb revascularisation, a study shows.

“While the effect size is modest, our data suggests that improving outpatient diabetic care may help impact limb salvage outcomes in high-risk patients that traditionally have been hard to improve”, say the researchers, led by Benjamin Brooke (University of Utah School of Medicine, Salt Lake City, USA).

They add that the benefits “are magnified when we consider the cost of amputations, re-interventions, and readmissions for diabetic patients with CLI [critical limb ischaemia] on a population level.”

The team based quality of diabetic care on the average annual rate of serum lipid and glycated haemoglobin testing in US health referral regions (HRR). There was an inverse association between HRR diabetic care quality, divided into quartiles, and the rate of major adverse limb events (MALE) among the patients.

Patients who underwent open revascularisation in an HRR in the top quartile had a 34.3% rate of MALE at 2 years, which was significantly lower than the 37.4% rate among patients treated in an HRR in the bottom quartile. The corresponding rates after endovascular procedures were 27.9% versus 29.6%, also a significant difference.

Amputation-free survival after either procedure was also significantly improved by high-quality diabetic care, at rates of 65.9% for the top quartile versus 63.4% for the bottom quartile. By contrast, the HRR diabetic quality care had no impact on either MALE or amputation-free survival rates among nondiabetic patients with CLI.

High-quality diabetic care reduced the risk of a combined outcome of amputation or mortality by a significant 6% among diabetic patients after accounting for multiple confounders, and also reduced the likelihood of 30-day readmission by a significant 9%. Again, it had no influence on outcomes in nondiabetic patients.

Brooke et al say their findings highlight the importance of regular testing for diabetics. “Testing enables identification of patients who are poorly medically managed, as well as to ensure those patients on proper regimens are maintained”, they write in the Annals of Vascular Surgery.

The team adds that “maintaining tight chronic control of serum glucose and lipid levels in diabetics should help promote improved wound healing, help prevent infections, decelerate the progression of atherosclerosis, and reduce the overall number of complications that can lead to re-intervention, amputation, or mortality.”

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