{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T11:46:23Z","timestamp":1784288783744,"version":"3.55.0"},"reference-count":25,"publisher":"American Diabetes Association","issue":"4","license":[{"start":{"date-parts":[[2019,3,20]],"date-time":"2019-03-20T00:00:00Z","timestamp":1553040000000},"content-version":"vor","delay-in-days":34,"URL":"http:\/\/www.diabetesjournals.org\/content\/license"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,4,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>An association between variability in clinical parameters (HbA1c, blood pressure, cholesterol, and uric acid) and risk of complications in type 2 diabetes has been reported. In this analysis, we investigated to what extent such variability is associated with overall quality of care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>The quality of care summary score (Q-score) represents a validated, overall quality of care indicator ranging between 0 and 40; the higher the score, the better the quality of care provided by the diabetes center. We identified patients with five or more measurements of clinical parameters after the assessment of the Q-score. Multiple linear regression analyses assessed the role of the Q-score in predicting the variability of the different parameters.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Overall, 273,888 patients were analyzed. The variability of all the parameters systematically increased with decreasing Q-score values. At multivariate linear regression analysis, compared with a Q-score &amp;gt;25, a score &amp;lt;15 was associated with a significantly larger variation in HbA1c, blood pressure, uric acid, total cholesterol, and LDL cholesterol and a lower variation in HDL cholesterol. The analysis of standardized \u03b2 coefficients show that the Q-score has a larger impact on the variability of HbA1c (0.34; P &amp;lt; 0.0001), systolic blood pressure (0.21; P &amp;lt; 0.0001), total cholesterol (0.21; P &amp;lt; 0.0001), and LDL cholesterol (0.20; P &amp;lt; 0.0001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>The variability of risk factors for diabetic complications is associated with quality of care. Quality of care improvement initiatives should be targeted to increase the achievement of the recommended target while reducing such variability.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc18-1471","type":"journal-article","created":{"date-parts":[[2019,2,15]],"date-time":"2019-02-15T00:59:11Z","timestamp":1550192351000},"page":"514-519","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":30,"title":["Overall Quality of Care Predicts the Variability of Key Risk Factors for Complications in Type 2 Diabetes: An Observational, Longitudinal Retrospective Study"],"prefix":"10.2337","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7955-4684","authenticated-orcid":false,"given":"Antonio","family":"Ceriello","sequence":"first","affiliation":[{"name":"Department of Cardiovascular and Metabolic Diseases, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8696-4238","authenticated-orcid":false,"given":"Maria Chiara","family":"Rossi","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"De Cosmo","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Scientific Institute \u201cCasa Sollievo della Sofferenza,\u201d San Giovanni Rotondo, Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Lucisano","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Pontremoli","sequence":"additional","affiliation":[{"name":"Department of Cardionephrology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Fioretto","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Padua, Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4709-8696","authenticated-orcid":false,"given":"Carlo","family":"Giorda","sequence":"additional","affiliation":[{"name":"Diabetes and Metabolism Unit, Department of Internal Medicine, ASL Turin 5, Chieri, Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Pacilli","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Scientific Institute \u201cCasa Sollievo della Sofferenza,\u201d San Giovanni Rotondo, Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Viazzi","sequence":"additional","affiliation":[{"name":"Department of Cardionephrology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppina","family":"Russo","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Nicolucci","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2019,2,14]]},"reference":[{"key":"2022031300191593100_B1","doi-asserted-by":"crossref","first-page":"2166","DOI":"10.2337\/dc08-0469","article-title":"Baseline quality-of-care data from 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