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Title: The impact of the quality of care and other factors on progression of chronic kidney disease in Thai patients with Type 2 Diabetes Mellitus: A nationwide cohort study
Authors: Sonthon P.
Promthet S.
Changsirikulchai S.
Rangsin R.
Thinkhamrop B.
Rattanamongkolgul S.
Hurst C.P.
Keywords: hemoglobin A1c
high density lipoprotein cholesterol
glycosylated hemoglobin
hemoglobin A1c protein, human
chronic kidney failure
cohort analysis
controlled study
cross-sectional study
disease course
follow up
health care quality
health insurance
insulin sensitivity
major clinical study
non insulin dependent diabetes mellitus
retrospective study
Thai (people)
chronic kidney failure
disease course
middle aged
non insulin dependent diabetes mellitus
very elderly
Age Factors
Aged, 80 and over
Cohort Studies
Diabetes Mellitus, Type 2
Disease Progression
Hemoglobin A, Glycosylated
Middle Aged
Quality of Health Care
Renal Insufficiency, Chronic
Retrospective Studies
Issue Date: 2017
Abstract: Objective: The present study investigates the impact of quality of care (QoC) and other factors on chronic kidney disease (CKD) stage progression among Type 2 Diabetes Mellitus (T2DM) patients. Methods: This study employed a retrospective cohort from a nationwide Diabetes and Hypertension study involving 595 Thai hospitals. T2DM patients who were observed at least 2 times in the 3 years follow-up (between 2011–2013) were included in our study. Ordinal logistic mixed effect regression modeling was used to investigate the association between the QoC and other factors with CKD stage progression. Results: After adjusting for covariates, we found that the achievement of the HbA1c clinical targets (≤7%) was the only QoC indicator protective against the CKD stage progression (adjusted OR = 0.76; 95%CI = 0.59–0.98; p<0.05). In terms of other covariates, age, occupation, type of health insurance, region of residence, HDL-C, triglyceride, hypertension and insulin sensitizer were also strongly associated with CKD stage progression. Conclusions: This cohort study demonstrates the achievement of the HbA1c clinical target (≤7%) is the only QoC indicator protective against progression of CKD stage. Neither of the other clinical targets (BP and LDL-C) nor any process of care targets could be shown to be associated with CKD stage progression. Therefore, close monitoring of blood sugar control is important to slow CKD progression, but long-term prospective cohorts are needed to gain better insights into the impact of QoC indicators on CKD progression. © 2017 Sonthon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
ISSN: 19326203
Appears in Collections:Scopus 1983-2021

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