To update and extend a previous cross-sectional international comparison of glycaemic control in people with type 1 diabetes. Methods: Data were obtained for 520,392 children and adults with type 1 diabetes from 17 population and five clinic-based data sources in countries or regions between 2016 and 2020. Median HbA 1c (IQR) and proportions of individuals with HbA 1c < 58 mmol/mol (<7.5%), 58-74 mmol/mol (7.5-8.9%) and ≥75 mmol/mol (≥9.0%) were compared between populations for individuals aged <15, 15-24 and ≥25 years. Logistic regression was used to estimate the odds ratio (OR) of HbA 1c < 58 mmol/mol (<7.5%) relative to ≥58 mmol/mol (≥7.5%), stratified and adjusted for sex, age and data source. Where possible, changes in the proportion of individuals in each HbA 1c category compared to previous estimates were calculated.Results: Median HbA 1c varied from 55 to 79 mmol/mol (7.2 to 9.4%) across data sources and age groups so a pooled estimate was deemed inappropriate. OR (95% CI) for HbA 1c < 58 mmol/mol (<7.5%) were 0.91 (0.90-0.92) for women 18 Joint municipal authority for North Karelia social and health services (Siunsote),
Background A new special reimbursement scheme (SRS) for non-insulin medications used for treatment of hyperglycaemia in type 2 diabetes (T2D) was implemented in Finland on January 1, 2017. The new SRS affected all community-dwelling Finnish T2D patients as all community-dwelling residents are eligible for reimbursement for prescription medications. The aim of the study was to evaluate the impact of this co-payment increase on glycaemic control among Finnish T2D patients. Methods Data on glycaemic control were collected with HbA1c measures from electronic health records from primary health care and specialized care in the North Karelia region, Finland, from patients with a confirmed T2D diagnosis in 2012 who were alive on January 1, 2017 (n = 8436). Average HbA1c levels were measured monthly 36 months before and 33 months after the policy change. Consumption of diabetes medications was measured with defined daily doses (DDDs) based on reimbursed medication purchases. Interrupted time series design analysed with segmented regression model was applied to examine the effect of the policy change on average HbA1c levels. Results Eight thousand one hundred forty-three T2D patients had at least one HbA1c measurement within 01/2014–9/2019. Mean age of the patients was 68.1 (SD 11.3) years and 53.0% were women. Average time since T2D diagnosis was 11.5 (SD 6.1) years. An estimated increase of 0.81 (95% confidence interval, CI, 0.04–1.58) mmol/mol in average HbA1c levels was detected at the time of the policy change. In subgroup analyses, strongest effects were detected among patients who used only other diabetes medications than insulin or metformin in 2016 (3.56 mmol/mol, 95% CI 2.50–4.62). Meanwhile, yearly consumption of diabetes medications decreased slightly from 618.9 (SD 487.8) DDDs/patient in 2016 to 602.9 (SD 475.6) DDDs/patient in 2017 (p = 0.048). Conclusions Simultaneously with the increase of the co-payment level, the average HbA1c level increased among T2D patients from the North Karelia region, Finland. This may be explained by the decreased consumption of diabetes medications between 2016 and 2017. Special attention should be allocated to glycaemic control of patients utilizing only other antidiabetic medications than metformin or insulin.
Summary Aims This study assessed type 2 diabetes treatment outcomes and process indicators using a comprehensive type 2 diabetes patient cohort in North Karelia, Finland, from 2011 to 2016. Methods Data from all diagnosed type 2 diabetes patients (n = 8429) living in North Karelia were collated retrospectively from regional electronic patient records. We assessed whether HbA1c and low‐density lipoprotein (LDL) were measured and managed as recommended. Results The HbA1c measurement rate improved (78% vs 89%) during 2011‐2012 and 2015‐2016, but a gradual deterioration in glycaemic control (HbA1c < 7.0% or 53 mmol/mol) was observed among both females (75% vs 67%) and males (72% vs 64%). The LDL measurement rate initially improved from the baseline. LDL control (<2.5 mmol/L) improved among both females (52% vs 59%) and males (58% vs 66%). A gender difference was observed in the achievement of the treatment target for LDL, with females showing worse control. Conclusions Low‐density lipoprotein (LDL) control in type 2 diabetes patients has improved, but the existence of gender disparities needs further attention. Maintaining appropriate HbA1c control among type 2 diabetes patients over time appears to be difficult. Active follow‐up and tailored treatment have the potential to improve the quality of care. Electronic patient records could be more efficiently used to improve the quality of care and to support decision‐making.
Background: In North Karelia, Finland, the regional electronic health records (EHRs) enable flexible data retrieval and area-level analyses. The aim of this study was to assess the early detection of type 2 diabetes (T2D) in the region and to evaluate the performed activities in order to improve the processes between the years 2012 and 2017. Methods: Patients with T2D were identified from the EHRs using the ICD-10 codes registered during any visit to either primary or specialized care. The prevalence of T2D was calculated for the years 2012, 2015, and 2017 on the municipality level. The number of people found in the EHRs with diabetes was compared with the number found in the national register of medication reimbursement rights. Results: In 2012, the age-adjusted prevalence of T2D in North Karelia varied considerably between municipalities (5.5%-8.6%). These differences indicate variation in the processes of early diagnosis. The findings were discussed in the regional network of health professionals treating patients with T2D, resulting in sharing experiences and best practices. In 2017, the differences had notably diminished, and in most municipalities, the prevalence exceeded 8%. The regional differences in the prevalence and their downward trend were observed both in the EHRs and in the medication reimbursement rights register. Conclusion: Clear differences in the prevalence of T2D were detected between municipalities. After visualizing these differences and providing information for the professionals, the early detection of T2D improved and the regional differences decreased. The EHRs are a valuable data source for knowledge-based management and quality improvement.
Background Evidence-based guidelines include concrete treatment targets that can be used as process and outcome indicators in the evaluation of the quality of healthcare services and diabetes care. Quality improvement can be evaluated by monitoring longitudinal trends in the care indicators on the system level. The aim of this study is to describe trends in the processes and outcomes of care among people with type 2 diabetes in North Karelia, Finland. Methods The data consist of all adults with type 2 diabetes (identified from the EHRs using ICD-10 codes) who used primary or specialized care services in North Karelia during 2012–2017. The diabetes care was evaluated using the measurement activity, treatment levels, and the achievement of the treatment targets for HbA1c and LDL as care indicators. Logistic and linear models with generalized estimating equations were used to assess the differences between years, sexes, and age groups. Results The proportion of patients with annual measurement varied between 75.8 and 78.1% for HbA1c and between 67.4 and 69.1% for LDL during a five-year follow-up. The changes in average levels were moderate: a 0.2% (2 mmol/mol) increase for HbA1c and a 0.1 mmol/l decrease for LDL. Anyway, the proportion of patients meeting the treatment target for HbA1c decreased from 72.7 to 67.3% (age-adjusted decrease: 5.7%p, 95% CI: 4.5–6.9) and for LDL it increased from 53.4 to 59.5% (age-adjusted increase: 5.6%p, 95% CI: 4.2–7.0). Women were measured and met the HbA1c target level more often compared with men. Conversely, men met the LDL target level more often than women, and the age-adjusted difference between sexes increased smoothly from 7.9%p to 11.7%p. Conclusions The achievements in relation to type 2 diabetes care in North Karelia are very good, but no major improvement was observed during follow-up. HbA1c levels had a rising tendency and LDL levels declining tendency indicating quality improvement in LDL management, but challenges in further improvement in glucose control.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.