ClinicalCodes.org
An online clinical codes repository to improve validity and reproducibility of medical database research
Research article:
Glucose, blood pressure and cholesterol levels and their relationships to clinical outcomes in type 2 diabetes: a retrospective cohort study
Reference:
Evangelos Kontopantelis, David A Springate, David Reeves, Darren M Ashcroft, Martin Rutter, Iain Buchan, Tim Doran(2015) Glucose, blood pressure and cholesterol levels and their relationships to clinical outcomes in type 2 diabetes: a retrospective cohort study. Diabetologia, doi: 10.1007/s00125-014-3473-8
- Link to fulltext article
- Abstract
- Background: Observational data have been used to inform target levels for modifiable risk factors in type 2 diabetes but these data are limited by confounding. We aimed to describe the shape of observed relationships between risk factor levels and clinically important outcomes in type 2 diabetes after adjusting for multiple confounders. Methods: We used retrospective longitudinal data on 246,544 adults with type 2 diabetes from 600 practices contributing to the Clinical Practice Research Datalink between 2006 and 2012. Proportional hazards regression models quantified the risks of mortality, microvascular or macrovascular events associated with four modifiable risk factors: glycated haemoglobin (HbA1c), systolic and diastolic blood pressure and total cholesterol, while controlling for numerous patient and practice covariates. Findings: U-shaped relationships were observed between all-cause mortality and levels of the four risk factors. The lowest risks were associated with HbA1c 7.25-7.75%; total cholesterol 3.5-4.5 mmol/L; systolic blood pressure 135-145 mmHg; and diastolic blood pressure 82.5-87.5 mmHg. coronary and stroke mortality related to the four risk factors in a positive, curvilinear way, with the exception of blood pressure which related to coronary deaths in a U-shape. Macrovascular events showed a positive and curvilinear relationship with HbA1c but U-shaped for total cholesterol and systolic blood pressure. Microvascular related to the four risk factors in a curvilinear way: positive for HbA1c and systolic blood pressure but negative for cholesterol and diastolic blood pressure. Interpretation: We identified several relationships which, when considered in the light of relevant trial data, support a call for major changes to clinical practice. Most importantly, our results support trial data indicating that normalisation of glucose and blood pressure can lead to poorer outcomes, which makes a strong case for target ranges for these risk factors rather than target levels.
- Author for correspondence
- Evangelos Kontopantelis
- Email for correspondence
- E.Kontopantelis@manchester.ac.uk
Code list: asthma_clinicals
66 codes in list
| Code | Coding system | Description | Entity type | List name | resolve_code | ||
|---|---|---|---|---|---|---|---|
| 173A.00 | Read | Exercise induced asthma | diagnostic | asthma_clinicals | 0 | ||
| 173c.00 | Read | Occupational asthma | diagnostic | asthma_clinicals | 0 | ||
| 173d.00 | Read | Work aggravated asthma | diagnostic | asthma_clinicals | 0 | ||
| 1780.00 | Read | Aspirin induced asthma | diagnostic | asthma_clinicals | 0 | ||
| 1O2..00 | Read | Asthma confirmed | diagnostic | asthma_clinicals | 0 | ||
| 2126200 | Read | Asthma resolved | diagnostic | asthma_clinicals | 1 | ||
| 212G.00 | Read | Asthma resolved | diagnostic | asthma_clinicals | 1 | ||
| 663j.00 | Read | Asthma - currently active | diagnostic | asthma_clinicals | 0 | ||
| 663V000 | Read | Occasional asthma | diagnostic | asthma_clinicals | 0 | ||
| 663V100 | Read | Mild asthma | diagnostic | asthma_clinicals | 0 | ||
| 663V200 | Read | Moderate asthma | diagnostic | asthma_clinicals | 0 | ||
| 663V300 | Read | Severe asthma | diagnostic | asthma_clinicals | 0 | ||
| H312000 | Read | Chronic asthmatic bronchitis | diagnostic | asthma_clinicals | 0 | ||
| H33..00 | Read | Asthma | diagnostic | asthma_clinicals | 0 | ||
| H330.00 | Read | Extrinsic (atopic) asthma | diagnostic | asthma_clinicals | 0 | ||
| H330000 | Read | Extrinsic asthma without status asthmaticus | diagnostic | asthma_clinicals | 0 | ||
| H330011 | Read | Hay fever with asthma | diagnostic | asthma_clinicals | 0 | ||
| H330100 | Read | Extrinsic asthma with status asthmaticus | diagnostic | asthma_clinicals | 0 | ||
| H330.11 | Read | Allergic asthma | diagnostic | asthma_clinicals | 0 | ||
| H330111 | Read | Extrinsic asthma with asthma attack | diagnostic | asthma_clinicals | 0 | ||
| H330.12 | Read | Childhood asthma | diagnostic | asthma_clinicals | 0 | ||
| H330.13 | Read | Hay fever with asthma | diagnostic | asthma_clinicals | 0 | ||
| H330.14 | Read | Pollen asthma | diagnostic | asthma_clinicals | 0 | ||
| H330z00 | Read | Extrinsic asthma NOS | diagnostic | asthma_clinicals | 0 | ||
| H331.00 | Read | Intrinsic asthma | diagnostic | asthma_clinicals | 0 | ||
| H331000 | Read | Intrinsic asthma without status asthmaticus | diagnostic | asthma_clinicals | 0 | ||
| H33..11 | Read | Bronchial asthma | diagnostic | asthma_clinicals | 0 | ||
| H331100 | Read | Intrinsic asthma with status asthmaticus | diagnostic | asthma_clinicals | 0 | ||
| H331.11 | Read | Late onset asthma | diagnostic | asthma_clinicals | 0 | ||
| H331111 | Read | Intrinsic asthma with asthma attack | diagnostic | asthma_clinicals | 0 | ||
| H331z00 | Read | Intrinsic asthma NOS | diagnostic | asthma_clinicals | 0 | ||
| H332.00 | Read | Mixed asthma | diagnostic | asthma_clinicals | 0 | ||
| H334.00 | Read | Brittle asthma | diagnostic | asthma_clinicals | 0 | ||
| H33z.00 | Read | Asthma unspecified | diagnostic | asthma_clinicals | 0 | ||
| H33z.11 | Read | Hyperreactive airways disease | diagnostic | asthma_clinicals | 0 | ||
| H33z200 | Read | Late-onset asthma | diagnostic | asthma_clinicals | 0 | ||
| H33zz00 | Read | Asthma NOS | diagnostic | asthma_clinicals | 0 | ||
| H33zz11 | Read | Exercise induced asthma | diagnostic | asthma_clinicals | 0 | ||
| H33zz12 | Read | Allergic asthma NEC | diagnostic | asthma_clinicals | 0 | ||
| H35y600 | Read | Sequoiosis (red-cedar asthma) | diagnostic | asthma_clinicals | 0 | ||
| H35y700 | Read | Wood asthma | diagnostic | asthma_clinicals | 0 | ||
| H47y000 | Read | Detergent asthma | diagnostic | asthma_clinicals | 0 | ||
| 3052AT | OXMIS | PSYCHOGENIC ASTHMA | diagnostic | asthma_clinicals | 0 | ||
| 493 | OXMIS | ASTHMA | diagnostic | asthma_clinicals | 0 | ||
| 493 AA | OXMIS | ASTHMA ACUTE | diagnostic | asthma_clinicals | 0 | ||
| 493 AB | OXMIS | ASTHMA ATTACK | diagnostic | asthma_clinicals | 0 | ||
| 493 AD | OXMIS | ASTHMA OCCASIONAL | diagnostic | asthma_clinicals | 0 | ||
| 493 AE | OXMIS | ASTHMA SEASONAL | diagnostic | asthma_clinicals | 0 | ||
| 493 AI | OXMIS | ASTHMA SEVERITY MILD | diagnostic | asthma_clinicals | 0 | ||
| 493 AJ | OXMIS | ASTHMA SEVERITY MODERATE | diagnostic | asthma_clinicals | 0 | ||
| 493 AK | OXMIS | ASTHMA SEVERITY SEVERE | diagnostic | asthma_clinicals | 0 | ||
| 493 AR | OXMIS | ASTHMA RESOLVED | diagnostic | asthma_clinicals | 1 | ||
| 493 BD | OXMIS | ASTHMA AND BRONCHITIS | diagnostic | asthma_clinicals | 0 | ||
| 493 BR | OXMIS | BRONCHIAL ASTHMA | diagnostic | asthma_clinicals | 0 | ||
| 493 C | OXMIS | CROUP ASTHMATIC | diagnostic | asthma_clinicals | 0 | ||
| 493 CH | OXMIS | CHILDHOOD ASTHMA | diagnostic | asthma_clinicals | 0 | ||
| 493 EA | OXMIS | ASTHMA EXERCISE INCLUDED | diagnostic | asthma_clinicals | 0 | ||
| 493 EB | OXMIS | ASTHMA EXERCISE INDUCED | diagnostic | asthma_clinicals | 0 | ||
| 493 EP | OXMIS | ASTHMA EPISODIC | diagnostic | asthma_clinicals | 0 | ||
| 493 GR | OXMIS | ASTHMA ALLERGIC GRASS | diagnostic | asthma_clinicals | 0 | ||
| 493 GS | OXMIS | ASTHMA POLLEN INITIATED | diagnostic | asthma_clinicals | 0 | ||
| 493 HT | OXMIS | INTRINSIC ASTHMA | diagnostic | asthma_clinicals | 0 | ||
| 493 JC | OXMIS | CHRONIC ASTHMA | diagnostic | asthma_clinicals | 0 | ||
| 493 NA | OXMIS | NOCTURNAL ASTHMA | diagnostic | asthma_clinicals | 0 | ||
| 691 TM | OXMIS | ECZEMA WITH ASTHMA | diagnostic | asthma_clinicals | 0 | ||
| L4930LO | OXMIS | LATE ONSET ASTHMA | diagnostic | asthma_clinicals | 0 |
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Asthma diagnosis is defined as a patient having at least one code from [asthma_clinicals] up to the end of the QOF year in question plus at least one code from [asthma_drugs] in the preceding year. Patients whose most recent clinical code in a year is a resolve code in a given year are not included in the definition.