Specialist Advice Does Not Modify the Risk of Death of Diabetic 2 Patients

Specialist Advice Does Not Modify the Risk of Death of Diabetic 2 Patients

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Battaggia Alessandro
Scuola Veneta di Medicina Generale Via Pelosa, 78 -35030 Selvazzano dentro Padova, Italy


Context: A recent meta-analysis (Bonora and coll.) reports benefits on death-risk for Italian diabetic patients mainly followed by the diabetic clinics of the National Health Service. Aims: A) to do a critical appraisal of the meta-analysis by Bonora and coll. B) to verify its results conducting a controlled cohort study based on clinical records of a primary care setting. Methods: (A) We evaluated the meta-analysis by Bonora through AMSTAR II checklist and the trials recruited in the review through ROBINS-I tool. (B) We analysed a cohort of diabetes 2 patients living in Veneto (Italy) and followed from 1/1/2009 to 12/31/2017 to compare the risk of death of a control group (i.e. never followed by specialists) with that of another two groups (i.e. respectively, followed by one specialist visit or by at least two visits in the last three years). We used a time-to-event approach (Cox model) for the main analysis; complementary designs were also tested (Restricted design and Matched design). Statistical adjustments were made both through Multivariate Cox regression and Propensity score. For the adjustments, the covariates considered were: age, sex, severity of diabetes, comorbidity, laboratory values, duration of diabetes and drugs use. Results: (A) The meta-analysis by Bonora shows to be affected by serious pitfalls (B) A cohort of 6530 diabetic patients (none visit: n=3441; one visit: n=947; two or more visits: n=2142) was followed for a mean of 7.32y. Main multivariate analysis was not able to demonstrate any difference in mortality between groups exposed or not exposed to specialist advice: one visit HR=1.01 (0.98-1.03); two or more visits HR=1.12 (0.88-1.43). These results were confirmed by all other analytical approaches. Conclusion: Mortality in diabetes2 is not influenced by specialist consultant. Our results differ by those reported by the meta-analysis because of our better adjustment for prognostic and confounding factors. Most of diabetes 2 patients should be entrusted with confidence to primary care facilities.

Article Info

Article Type
Original Article
Publication history
Received: Wed 11, Sep 2019
Accepted: Tue 24, Sep 2019
Published: Wed 02, Oct 2019
© 2023 Battaggia Alessandro. 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. Hosting by Science Repository.
DOI: 10.31487/j.JICOA.2019.04.02