Attainment of the QOF HbA1c (≤ 7.5% or 59 mmol/mol), BP (≤ 140/80 mmHg), and total cholesterol (≤ 5 mmol/L) indicators within the 2010–2011 financial year was defined according to the QOF Business Rules v38.0 [19]. Thus, the most recent measurements in 2010–2011 were used as the basis for indicator status, and the indicator was considered not to be met where no measurement was available. A further exposure variable describing implementation of NDA annual care processes throughout the 2010–2011 year was created by categorising the number of processes completed as 0–3, 4–6, or 7–9. The NDA care processes include the following: HbA1c, blood pressure, cholesterol, serum creatinine, urine albumin/creatinine ratio, BMI measurements, examination for foot ulcer risk, record of smoking status, and completion of digital retinal screening.

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