Contacting dropouts from type 2 diabetes care in public primary health care: description of the patient population

Abstract

ObjectiveTo characterize dropouts from type-2 diabetes (T2D) care in communal primary health care.DesignAn observational study.SettingIn a Finnish city, patients with T2D who had not contacted the public primary health care system during the past 12 months were identified with a computer based search and contacted by a trained diabetes nurse.SubjectsDropouts from T2D treatment.Main outcome measuresDemographic factors, laboratory parameters, examinations, medications, and comorbidities.ResultsOf the patients with T2D, 10% (n = 356) were dropouts and 60% of them were men. Median HbA1c was 6.5 (QR for 25% and 75%: 6.0, 7.7) %, (45 [42,61] mmol/mol). Of the dropouts, 14% had HbA1c ≥ 9.0% (75 mmol/mol), and these patients were younger than the other dropouts (mean age 54.4 [SD 10.8] years vs. 60.6 [9.4] years, p < 0.001). Median low-density lipoprotein (LDL) cholesterol level was 2.8 (QR 2.1, 3.4) mmol/l. Median systolic blood pressure (BP) was 142 (QR 130, 160) mm Hg. Median diastolic BP was 86 (78, 94) mm Hg. Of the dropouts, 83% had comorbidities and 62% were prescribed metformin as a treatment.ConclusionsTen percent of T2D patients were dropouts of whom those with a poor glycaemic control were younger than the other dropouts. BP and LDL cholesterol concentrations were non-optimal among the majority of the dropouts. Metformin was prescribed less frequently to the dropouts than is usual for T2D patients. The comorbidities were equally common among the dropouts as among the other T2D patients.Key Points Which kinds of patients are dropouts from type-2 diabetes care is not known.• One-tenth of the patients with T2D were dropouts and they generally had good glycaemic control.• Blood pressure and LDL cholesterol concentrations were non-optimal among the majority of the dropouts.• Fourteen percent of these dropouts had HbA1c > 9% (75 mmol/mol) and they were more often younger than the other dropouts.

Relationship between number of contacts between previous dropouts with type 2 diabetes and health care professionals on glycaemic control: A cohort study in public primary health care

“…In the public primary health care centre of the city of Vantaa, Finland, we carried out a study focusing upon the phenomenon of dropout. According to our study findings, one in ten patients with T2D was a dropout from the public primary diabetes health care system [5]. Further, the dropouts with T2D were difficult to bring back to the system [6].…”

“…Previous studies focusing on the phenomenon of dropouts with T2D have concentrated mainly on prevention of relapses and/or on description of the dropouts [5,[16][17][18][19]. Although T2D is significant in view of public health [20] studies concerning how previous dropouts from T2D care use health services do not exist.…”

“…In order to improve diabetes treatment of all these putative dropouts and to bring them back to the public primary diabetes care system a trained diabetes nurse contacted these persons. We recorded afterwards the effects of the work performed by the community primary health care nurses and general practitioners [5]. At the baseline visit the participant's status was assessed, laboratory tests were taken, diabetes counselling was given and treatment was enhanced when needed [5].…”

“…We recorded afterwards the effects of the work performed by the community primary health care nurses and general practitioners [5]. At the baseline visit the participant's status was assessed, laboratory tests were taken, diabetes counselling was given and treatment was enhanced when needed [5]. The "second follow-up" visit was the closest visit more than one year after the first visit (13-30 months after the baseline visit) and included the same assessments as the baseline visit.…”

Impact of intervention on metabolic outcomes among dropouts with type 2 diabetes

“…In the public primary health care center of the city of Vantaa, Finland, we investigated the phenomenon of dropout. In 2009, every tenth patient with T2D was a 'dropout' from the public primary diabetes care system [5]. Among these patients, the level of hemoglobin A1c (HbA 1c ) was satisfactory whereas low-density lipoprotein (LDL) cholesterol and blood pressure (BP) were nonoptimal [5].…”