On the other hand, complications are potentially modifiable; therefore, implementation of practice guidelines to reduce complications could improve LOS and impact health care costs.
This was accounted for by the increased use of mainly two definitions: presence of an identifiable modifiable cause and adherence to guidelines.
In that study, despite the fact that most risk factors for cardiovascular disease are modifiable and that Joint European guidelines on cardiovascular disease prevention target high-risk patients, the trends in management were described as disappointing, including that guidelines seem to be ignored [ 20].
In this study neither adequate glycemic control nor optimal treatment of modifiable cardiovascular risk factors according to guidelines was achieved in persons with type 2 diabetes.
In this study only a small proportion of persons with type 2 diabetes reached adequate glycemic control as well as optimal treatment of modifiable cardiovascular risk factors according to guidelines.
It is possible that our study participants included older people who, although they had a confirmed CVD risk ≥20% as per national guidelines, actually had a modifiable level of risk that was lower than that of younger people with an absolute risk <20%.
We previously found that prenatal records from different Canadian jurisdictions varied markedly in their inclusion of assessment questions and intervention guides related to prenatal smoking [ 9] and alcohol use [ 10], despite the availability of evidence-based national guidelines for addressing these modifiable risk factors for adverse maternal and infant health outcomes [ 11, 12].
These risk factors were derived from the literature, national guidelines, and expert opinion as modifiable or treatable risk factors for the future development and/or diagnosis of diabetes [ 11, 12].
For raised cardiovascular disease risk, international guidelines suggested that these were the modifiable risk factors of hypertension, smoking, obesity, raised cholesterol and lack of exercise.
Variation associated with hospital characteristics may be modifiable with hospital level interventions such as written guidelines for standardised management having been shown to be associated with an increase in the vaginal birth after caesarean section rate [ 49, 50].
Owing to the major role of low-density lipoprotein (LDL) cholesterol as a modifiable risk factor, over the years, several international guidelines have recommended the achievement of LDL goals in patients with different CV risk profiles (Table 2).
