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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: Epilepsy_clinicals

119 codes in list

Code Coding system Description Entity type List name resolve_code type
1B1W.00 Read Transient epileptic amnesia diagnostic Epilepsy_clinicals 0 diagnosis
2126000 Read Epilepsy resolved diagnostic Epilepsy_clinicals 1 diagnosis
212J.00 Read Epilepsy resolved diagnostic Epilepsy_clinicals 1 diagnosis
2932 Read PSYCHOSIS EPILEPTIC diagnostic Epilepsy_clinicals 0 diagnosis
3032EP Read EPILEPSY ALCOHOLIC diagnostic Epilepsy_clinicals 0 diagnosis
3450 Read EPILEPSY NONCONVULSIVE GENERALIZED diagnostic Epilepsy_clinicals 0 diagnosis
3451 Read GRAND MAL EPILEPSY diagnostic Epilepsy_clinicals 0 diagnosis
3453AT Read EPILEPSY AUTOMATISM diagnostic Epilepsy_clinicals 0 diagnosis
3453P Read EPILEPSY PERIPHERAL diagnostic Epilepsy_clinicals 0 diagnosis
3453T Read TEMPORAL LOBE EPILEPSY diagnostic Epilepsy_clinicals 0 diagnosis
3459A Read POST-TRAUMATIC EPILEPSY diagnostic Epilepsy_clinicals 0 diagnosis
3459AB Read ABDOMEN CONVULSIVE EQUIVALENT (EPILEPSY) diagnostic Epilepsy_clinicals 0 diagnosis
3459BA Read IDOPATHIC EPILEPSY diagnostic Epilepsy_clinicals 0 diagnosis
3459C Read EPILEPTIC COMA diagnostic Epilepsy_clinicals 0 diagnosis
3459CL Read EPILEPSY CLIMACTERIC diagnostic Epilepsy_clinicals 0 diagnosis
3459D Read ISCHAEMIC EPILEPSY diagnostic Epilepsy_clinicals 0 diagnosis
3459F Read FIT EPILEPTIC diagnostic Epilepsy_clinicals 0 diagnosis
3459M Read MIGRAINE EPILEPSY diagnostic Epilepsy_clinicals 0 diagnosis
3459N Read NOCTURNAL EPILEPSY diagnostic Epilepsy_clinicals 0 diagnosis
3459R Read EPILEPSY RESOLVED diagnostic Epilepsy_clinicals 1 diagnosis
667..00 Read Epilepsy monitoring diagnostic Epilepsy_clinicals 0 diagnosis
6672.00 Read Follow-up epilepsy assessment diagnostic Epilepsy_clinicals 0 diagnosis
6674.00 Read Epilepsy associated problems diagnostic Epilepsy_clinicals 0 diagnosis
6675.00 Read Fit frequency diagnostic Epilepsy_clinicals 0 EPILEPSY_2
6676.00 Read Last fit diagnostic Epilepsy_clinicals 0 diagnosis
6678.00 Read Epilepsy treatment changed diagnostic Epilepsy_clinicals 0 EPILEPSY_3
6679.00 Read Epilepsy treatment started diagnostic Epilepsy_clinicals 0 EPILEPSY_3
667A.00 Read Epilepsy treatment stopped diagnostic Epilepsy_clinicals 0 EPILEPSY_3
667B.00 Read Nocturnal epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
667C.00 Read Epilepsy control good diagnostic Epilepsy_clinicals 0 diagnosis
667D.00 Read Epilepsy control poor diagnostic Epilepsy_clinicals 0 diagnosis
667E.00 Read Epilepsy care arrangement diagnostic Epilepsy_clinicals 0 diagnosis
667F.00 Read Seizure free >12 months diagnostic Epilepsy_clinicals 0 EPILEPSY_4
667G.00 Read Epilepsy restricts employment diagnostic Epilepsy_clinicals 0 diagnosis
667H.00 Read Epilepsy prevents employment diagnostic Epilepsy_clinicals 0 diagnosis
667J.00 Read Epilepsy impairs education diagnostic Epilepsy_clinicals 0 diagnosis
667K.00 Read Epilepsy limits activities diagnostic Epilepsy_clinicals 0 diagnosis
667L.00 Read Epilepsy does not limit activities diagnostic Epilepsy_clinicals 0 diagnosis
667M.00 Read Epilepsy management plan given diagnostic Epilepsy_clinicals 0 diagnosis
667N.00 Read Epilepsy severity diagnostic Epilepsy_clinicals 0 diagnosis
667P.00 Read No seizures on treatment diagnostic Epilepsy_clinicals 0 EPILEPSY_2
667Q.00 Read 1 to 12 seizures a year diagnostic Epilepsy_clinicals 0 EPILEPSY_2
667R.00 Read 2 to 4 seizures a month diagnostic Epilepsy_clinicals 0 EPILEPSY_2
667S.00 Read 1 to 7 seizures a week diagnostic Epilepsy_clinicals 0 EPILEPSY_2
667T.00 Read Daily seizures diagnostic Epilepsy_clinicals 0 EPILEPSY_2
667V.00 Read Many seizures a day diagnostic Epilepsy_clinicals 0 EPILEPSY_2
667W.00 Read Emergency epilepsy treatment since last appointment diagnostic Epilepsy_clinicals 0 diagnosis
667X.00 Read No epilepsy drug side effects diagnostic Epilepsy_clinicals 0 EPILEPSY_3
8BIF.00 Read Epilepsy medication review diagnostic Epilepsy_clinicals 0 EPILEPSY_3
8BL3.00 Read Patient on maximal tolerated anticonvulsant therapy diagnostic Epilepsy_clinicals 0 EPILEPSY_4
9N0r.00 Read Seen in epilepsy clinic diagnostic Epilepsy_clinicals 0 diagnosis
9N4V.00 Read DNA - Did not attend epilepsy clinic diagnostic Epilepsy_clinicals 0 diagnosis
Eu05212 Read [X]Schizophrenia-like psychosis in epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
Eu05y11 Read [X]Epileptic psychosis NOS diagnostic Epilepsy_clinicals 0 diagnosis
Eu06013 Read [X]Limbic epilepsy personality diagnostic Epilepsy_clinicals 0 diagnosis
Eu80300 Read [X]Acquired aphasia with epilepsy [Landau - Kleffner] diagnostic Epilepsy_clinicals 0 diagnosis
F132100 Read Progressive myoclonic epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F25..00 Read Epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F250.00 Read Generalised nonconvulsive epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F250000 Read Petit mal (minor) epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F250011 Read Epileptic absences diagnostic Epilepsy_clinicals 0 diagnosis
F250100 Read Pykno-epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F250200 Read Epileptic seizures - atonic diagnostic Epilepsy_clinicals 0 diagnosis
F250300 Read Epileptic seizures - akinetic diagnostic Epilepsy_clinicals 0 diagnosis
F250500 Read Lennox-Gastaut syndrome diagnostic Epilepsy_clinicals 0 diagnosis
F250y00 Read Other specified generalised nonconvulsive epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F250z00 Read Generalised nonconvulsive epilepsy NOS diagnostic Epilepsy_clinicals 0 diagnosis
F251.00 Read Generalised convulsive epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F251000 Read Grand mal (major) epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F251011 Read Tonic-clonic epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F251111 Read Otohara syndrome diagnostic Epilepsy_clinicals 0 diagnosis
F251200 Read Epileptic seizures - clonic diagnostic Epilepsy_clinicals 0 diagnosis
F251300 Read Epileptic seizures - myoclonic diagnostic Epilepsy_clinicals 0 diagnosis
F251400 Read Epileptic seizures - tonic diagnostic Epilepsy_clinicals 0 diagnosis
F251500 Read Tonic-clonic epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F251y00 Read Other specified generalised convulsive epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F251z00 Read Generalised convulsive epilepsy NOS diagnostic Epilepsy_clinicals 0 diagnosis
F252.00 Read Petit mal status diagnostic Epilepsy_clinicals 0 diagnosis
F253.00 Read Grand mal status diagnostic Epilepsy_clinicals 0 diagnosis
F253.11 Read Status epilepticus diagnostic Epilepsy_clinicals 0 diagnosis
F254.00 Read Partial epilepsy with impairment of consciousness diagnostic Epilepsy_clinicals 0 diagnosis
F254000 Read Temporal lobe epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F254100 Read Psychomotor epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F254200 Read Psychosensory epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F254300 Read Limbic system epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F254400 Read Epileptic automatism diagnostic Epilepsy_clinicals 0 diagnosis
F254500 Read Complex partial epileptic seizure diagnostic Epilepsy_clinicals 0 diagnosis
F254z00 Read Partial epilepsy with impairment of consciousness NOS diagnostic Epilepsy_clinicals 0 diagnosis
F255.00 Read Partial epilepsy without impairment of consciousness diagnostic Epilepsy_clinicals 0 diagnosis
F255000 Read Jacksonian; focal or motor epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F255011 Read Focal epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F255012 Read Motor epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F255100 Read Sensory induced epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F255200 Read Somatosensory epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F255300 Read Visceral reflex epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F255311 Read Partial epilepsy with autonomic symptoms diagnostic Epilepsy_clinicals 0 diagnosis
F255400 Read Visual reflex epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F255500 Read Unilateral epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F255600 Read Simple partial epileptic seizure diagnostic Epilepsy_clinicals 0 diagnosis
F255y00 Read Partial epilepsy without impairment of consciousness OS diagnostic Epilepsy_clinicals 0 diagnosis
F255z00 Read Partial epilepsy without impairment of consciousness NOS diagnostic Epilepsy_clinicals 0 diagnosis
F257.00 Read Kojevnikov's epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F25B.00 Read Alcohol-induced epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F25C.00 Read Drug-induced epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F25D.00 Read Menstrual epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F25E.00 Read Stress-induced epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F25F.00 Read Photosensitive epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F25X.00 Read Status epilepticus; unspecified diagnostic Epilepsy_clinicals 0 diagnosis
F25y.00 Read Other forms of epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F25y000 Read Cursive (running) epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F25y100 Read Gelastic epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F25y200 Read Locl-rlt(foc)(part)idiop epilep&epilptic syn seiz locl onset diagnostic Epilepsy_clinicals 0 diagnosis
F25y300 Read Complex partial status epilepticus diagnostic Epilepsy_clinicals 0 diagnosis
F25y400 Read Benign Rolandic epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
F25yz00 Read Other forms of epilepsy NOS diagnostic Epilepsy_clinicals 0 diagnosis
F25z.00 Read Epilepsy NOS diagnostic Epilepsy_clinicals 0 diagnosis
F25z.11 Read Fit (in known epileptic) NOS diagnostic Epilepsy_clinicals 0 diagnosis
SC20000 Read Traumatic epilepsy diagnostic Epilepsy_clinicals 0 diagnosis
342 E OXMIS PARKINSONIAN EPILEPSY diagnostic Epilepsy_clinicals 0 diagnosis

2 comments have been posted.

Jan. 27, 2014, 7:57 a.m. - David Springate

Patients are classed as being diagnosed with epilepsy if they have at least one code from [epilepsy_clinicals] up to the end of the QOF year in question plus at least one code from [epilepsy_drugs] in the preceding year. Patients whose most recent clinical code in a given year is a resolve code are not included in the definition.

Jan. 27, 2014, 7:59 a.m. - David Springate

'type' coding: 'diagnostic' - Used to diagnose condition. 'EPILEPSY_2' - QOF indicator EPILEPSY 2. 'EPILEPSY_3' - QOF indicator EPILEPSY 3. 'EPILEPSY_4' - QOF indicator EPILEPSY 4.

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