Diabetes

Rational:

Diabetes is a complex group of diseases marked by high blood glucose (blood sugar) due to the body’s inability to make or use insulin. Left unmanaged, diabetes can lead to serious complications, including heart disease, stroke, hypertension, blindness, kidney disease, diseases of the nervous system, amputations and premature death [1]. During 2012-2014 5.6% of mortality cases in Israel were attributable to diabetes, becoming the fourth most common cause of death [2]. Three common diabetes comorbidities are included in the set of quality measures for individuals with diabetes: hypertension, dyslipidemia, and obesity. These conditions act as independent risk factors for cardiovascular morbidity and mortality, impede the achievement of glycemic control, and enhance the damage caused by high blood glucose to the vessels, hence increasing diabetes-related complications. Therefore, continuous monitoring and control of these conditions are important elements in the treatment of individuals with diabetes [1]. The initial definition of this quality measure in 2005 was based on cut-off values of 130/80 mmHg. However, later studies such as the ACCORD [3] showed that tight blood pressure control conferred no advantage in the prevention of cardiovascular disease, compared to looser control; thus leading to updates in most guidelines, suggesting a target blood pressure value of 140/90 mmHg in individuals with diabetes, similarly to the target in the general population [1]. The quality indicator was modified accordingly in 2012.