IntroductionType 2 diabetes is associated with severe micro- and macro-vascular complications. Physicians’ and patients’ adherence to follow-up guidelines permits postponing or reducing these complications. The objectives were to assess the level of adherence to fundamental follow-up guidelines and determine patients’ characteristics associated with this level of adherence in the context of Luxembourg, where no guidelines were implemented.Study populationThe exhaustive residing population treated for type 2 diabetes in Luxembourg during the 2000-2006 period (N = 21,068).MethodsSeven fundamental criteria were extracted from international guidelines (consultation with the treating physician, HbA1c tests, electrocardiogram, retinal, dental, lipid and renal check-ups). The factors associated with the level of adherence to those criteria were identified using a partial proportional odds model.ResultsIn 2006, despite 90% of the patients consulted at least 4 times their treating physician, only 0.6% completed all criteria; 55.0% had no HbA1c test (−8.6 points since 2000) and 31.1% had a renal check-up (+21.6 points). The sex (ORmale: 0.87 [95%CI, 0.83−0.92]), the nationality (ORNonEU: 0.64 [0.52−0.78]), the type of antidiabetic treatment (ORoral: 1.48 [1.35−1.63], ORmixed: 1.35 [1.20−1.52]) and the type of treating physician (ORG-ID: 0.47 [0.42−0.53]) were the main factors associated with the level of adherence in 2006 (3 or more criteria).ConclusionA large percentage of patients were not provided with a systematic annual follow-up between 2000 and 2006. This study highlighted the necessity to promote guidelines in Luxembourg, education for physicians and to launch a national discussion on a disease management program for diabetic patients.
BackgroundNational authorities have to follow the evolution of diabetes to implement public health policies. An algorithm was developed to identify patients with treated type 2 diabetes and estimate its annual prevalence in Luxembourg using health insurance claims when no diagnosis code is available.MethodsThe DIABECOLUX algorithm was based on patients' age as well as type and number of hypoglycemic agents reimbursed between 1995 and 2006. Algorithm validation was performed using the results of a national study based on medical data. Sensitivity, specificity and predictive values were estimated.ResultsThe sensitivity of the DIABECOLUX algorithm was found superior to 98.2%. Between 2000 and 2006, 22,178 patients were treated for diabetes in Luxembourg, among whom 21,068 for type 2 diabetes (95%). The prevalence was estimated at 3.79% in 2006 and followed an increasing linear trend during the period. In 2005, the prevalence was low for young age classes and increased rapidly from 40 to 70 for male and 80 for female, reaching a peak of, respectively 17.0% and 14.3% before decreasing.ConclusionsThe DIABECOLUX algorithm is relevant to identify treated type 2 diabetes patients. It is reproducible and should be transferable to every country using medico-administrative databases not including diagnosis codes. Although undiagnosed patients and others with lifestyle recommendations only were not considered in this study, this algorithm is a cheap and easy-to-use tool to inform health authorities. Further studies will use this tool with the aim of improving the quality of health care dedicated to diabetic patients in Luxembourg.
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