Evaluation of type 2 diabetes care management in nine primary care practices before and after implementation of the Criteria of Good Disease Management of Diabetes established by the Swiss Society of Endocrinology and Diabetology

Christ, Emanuel; Czock, Astrid; Renström, Frida; Ammeter, Tamara; Ebrahimi, Fahim; Zechmann, Stefan; Kutz, Alexander; Diem, Peter; Häuptle, Christian; Brändle, Michael

doi:10.4414/smw.2022.w30197

Cited by 3 publications

(3 citation statements)

References 20 publications

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“…The percentage of patients with diabetes successfully controlling their blood pressure (63.3%) and LDL cholesterol (54.4%) still lags the SSED guidelines. Our results are similar to a recent analysis of nine general practices in St Gallen,22 which reported that glycemic control was a little under 60%, and blood pressure and LDL cholesterol control was only achieved in half of the patients. In contrast, an analysis of 365 patients with type 2 diabetes at two tertiary care centers in the cities of Bern and St Gallen reported that blood pressure <140/90 mm Hg was achieved by 92% of patients with diabetes 23.…”

Section: Discussionsupporting

confidence: 91%

Trends in glycemic, blood pressure, and lipid control in adults with diabetes in Switzerland: the CoLaus|PsyCoLaus Study

Alkandari

Vaucher

Marques‐Vidal

2023

BMJ Open Diab Res Care

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AimTo assess the 15-year trends in the level of glycemic, blood pressure, and cholesterol control in adults with diabetes in a Swiss population-based cohort.Research design and methodsCoLaus|PsyCoLaus is a prospective cohort study of 6733 adults aged 35–75 years in Lausanne, Switzerland. Baseline recruitment was conducted in 2003–6 and was followed by three subsequent follow-ups in 2009–12, 2014–17 and 2018–21. In adults with diabetes, glycemic control was defined as fasting plasma glucose <7 mmol/L, blood pressure control as systolic and diastolic pressures of <140/90 mm Hg, and lipid control as non-high-density lipoprotein (non-HDL) cholesterol control <3.4 mmol/L.ResultsRates of glycemic control improved from 23.2% (95% CI 19.5 to 27.3) in 2003–6 to 32.8% (95% CI 28.1 to 37.8) in 2018–21. Blood pressure control also improved, from 51.5% at baseline (95% CI 46.8 to 56.2) to 63.3% (95% CI 58.2 to 68.1) 15 years later. The largest improvement was in cholesterol control, from 29.1% (95% CI 25.1 to 33.6) in 2003–6 to 56.3% (95% CI 51.1 to 61.4) in 2018–21. Overall, simultaneous control of all three improved from 5.5% (95% CI 3.7 to 8.1) at baseline to 17.2% (95% CI 13.7 to 21.5) 15 years later. Improvements in risk factor control tallied with an increase in the use of glucose-lowering agents, blood pressure-lowering medication, and statins. Men were less likely to achieve blood pressure control but presented with a better control of non-HDL cholesterol. Caucasians were less likely to achieve simultaneous control than non-Caucasians.ConclusionCardiovascular risk factor control in adults with diabetes in Switzerland has increased in the last 15 years, but there remains a margin for improvement.

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Section: Discussionsupporting

confidence: 91%

Trends in glycemic, blood pressure, and lipid control in adults with diabetes in Switzerland: the CoLaus|PsyCoLaus Study

Alkandari

Vaucher

Marques‐Vidal

2023

BMJ Open Diab Res Care

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“…Considering that non-adherence to diabetes medical standards (<2 × HbA1c, Lipid profile at target, nephropathy status and ophthalmologist visit per year) in diabetes care is associated with an increased probability of future hospitalization among patients with diabetes [26,27] (table 2). The suggested target in practice is ≥70 out of 100 points among all patients with type 2 diabetes mellitus [27].…”

Section: Adherence and Sged/ssed Scorementioning

confidence: 99%

“…Score[26,27]: suggested target: ≥70/100 points.Criteria Intervention Aim (on a yearly basis) PointsRegular visits General diabetes control <80% of patients with ≥3 visits10 Lifestyle measures BMI >25, physical exercise, and nutrition counselling <80% of patients have BMI ≤25 or if BMI >25 received counselling ≥1/year 5 Nicotin abuse: smoking cessation counselling >80% patients non-smokers or if active smokers received 15 LDL-C if <75 years of age LDL-Cholesterol measurement Annual mean: ≥63% of patients <2.6 mmol/l 10 Nephropathy screening Measurement of serum creatinine + microalbuminuria ≥80% of patients screened 10 Retinopathy screening Ophthalmological consultation ≥80% of patients screened at least every second year 10 Foot examination Pulses (Arteria dorsalis pedis, Arteria tibialis posterior), monofilament and vibration sense ≥80% of patients screened 10 BMI: Body Mass Index; DCCT: Diabetes Control and Complications Trial; HbA1c: haemoglobin A1c; LDL: low-density lipoprotein cholesterol; SGED/SSED: Swiss Society for Endocrinology and Diabetes Review article: Medical guidelines Swiss Med Wkly. 2023;153:40060…”

mentioning

confidence: 99%

Swiss recommendations of the Society for Endocrinology and Diabetes (SGED/SSED) for the treatment of type 2 diabetes mellitus (2023)

Gastaldi¹,

Leggett²,

Thalmann³

et al. 2023

Swiss Med Wkly

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As a first step, the authors emphasise lifestyle changes (increased physical activity, stopping smoking), blood pressure control, and lowering cholesterol). The initial medical treatment should always be a combination treatment with metformin and a sodium-glucose transporter 2 (SGLT-2) inhibitor or a glucagon-like 1 peptide (GLP-1) receptor agonist. Metformin is given first and up-titrated, followed by SGLT-2 inhibitors or GLP-1 receptor agonists. In persons with type 2 diabetes, if the initial double combination is not sufficient, a triple combination (SGLT-2 inhibitor, GLP-1 receptor agonist, and metformin) is recommended. This triple combination has not been officially tested in cardiovascular outcome trials, but there is more and more real-world experience in Europe and in the USA that proves that the triple combination with metformin, SGLT-2 inhibitor, and GLP-1 receptor agonist is the best treatment to reduce 3-point MACE, total mortality, and heart failure as compared to other combinations. The treatment with sulfonylurea is no longer recommended because of its side effects and higher mortality compared to the modern treatment with SGLT-2 inhibitors and GLP-1 receptor agonists. If the triple combination is not sufficient to reduce the HbA1c to the desired target, insulin treatment is necessary. A quarter of all patients with type 2 diabetes (sometimes misdiagnosed) require insulin treatment. If insulin deficiency is the predominant factor at the outset of type 2 diabetes, the order of medications has to be reversed: insulin first and then cardio-renal protective medications (SGLT-2 inhibitors, GLP-1 receptor agonists).

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Barriers to early diagnosis of chronic kidney disease and use of sodium‐glucose cotransporter‐2 inhibitors for renal protection: A comprehensive review and call to action

Czupryniak,

Mosenzon,

Rychlík

et al. 2024

Diabetes Obesity Metabolism

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Chronic kidney disease (CKD) affects approximately 13% of people globally, including 20%–48% with type 2 diabetes (T2D), resulting in significant morbidity, mortality, and healthcare costs. There is an urgent need to increase early screening and intervention for CKD. We are experts in diabetology and nephrology in Central Europe and Israel. Herein, we review evidence supporting the use of sodium‐glucose cotransporter‐2 (SGLT2) inhibitors for kidney protection and discuss barriers to early CKD diagnosis and treatment, including in our respective countries. SGLT2 inhibitors exert cardiorenal protective effects, demonstrated in the renal outcomes trials (EMPA‐KIDNEY, DAPA‐CKD, CREDENCE) of empagliflozin, dapagliflozin, and canagliflozin in patients with CKD. EMPA‐KIDNEY demonstrated cardiorenal efficacy across the broadest renal range, regardless of T2D status. Renoprotective evidence also comes from large real‐world studies. International guidelines recommend first‐line SGLT2 inhibitors for patients with T2D and estimated glomerular filtration rate (eGFR) ≥20 mL/min/1.73 m2, and that glucagon‐like peptide‐1 receptor agonists may also be administered if required for additional glucose control. Although these guidelines recommend at least annual eGFR and urine albumin‐to‐creatinine ratio screening for patients with T2D, observational studies suggest that only half are screened. Diagnosis is hampered by asymptomatic early CKD and under‐recognition among patients with T2D and clinicians, including limited knowledge/use of guidelines and resources. Based on our experience and on the literature, we recommend robust screening programmes, potentially with albuminuria self‐testing, and SGLT2 inhibitor reimbursement at general practitioner (GP) and specialist levels. High‐tech tools (artificial intelligence, smartphone apps, etc.) are providing exciting opportunities to identify high‐risk individuals, self‐screen, detect abnormalities in images, and assist with prescribing and treatment adherence. Better education is also needed, alongside provision of concise guidelines, enabling GPs to identify who would benefit from early initiation of renoprotective therapy; although, regardless of current renal function, cardiorenal protection is provided by SGLT2 inhibitor therapy.

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Evaluation of type 2 diabetes care management in nine primary care practices before and after implementation of the Criteria of Good Disease Management of Diabetes established by the Swiss Society of Endocrinology and Diabetology

Cited by 3 publications

References 20 publications

Trends in glycemic, blood pressure, and lipid control in adults with diabetes in Switzerland: the CoLaus|PsyCoLaus Study

Trends in glycemic, blood pressure, and lipid control in adults with diabetes in Switzerland: the CoLaus|PsyCoLaus Study

Swiss recommendations of the Society for Endocrinology and Diabetes (SGED/SSED) for the treatment of type 2 diabetes mellitus (2023)

Barriers to early diagnosis of chronic kidney disease and use of sodium‐glucose cotransporter‐2 inhibitors for renal protection: A comprehensive review and call to action

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