Maintenance of good glycaemic control is challenging – A cohort study of type 2 diabetes patient in North Karelia, Finland

Nazu, Nazma Akter; Lindström, Jaana; Rautiainen, Päivi; Tirkkonen, Hilkka; Wikström, Katja; Repo, Teppo; Laatikainen, Tiina

doi:10.1111/ijcp.13313

Cited by 9 publications

(13 citation statements)

References 30 publications

(41 reference statements)

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“…The estimated yearly increase of 0.84 mmol/mol (12*0.07 mmol/mol, 0.08% units) in average HbA1c levels observed in this study until the policy change at the beginning of 2017 is a bit over the magnitude of the estimated increase of 0.75 mmol/mol (0.07% units in HbA1c) per year that was observed in our previous study among the same population in 2011-2016 [33]. The small differences in results are due to differences in densities of follow-up (monthly level in the current study vs. yearly level in the paper by Nazu et al (2019)) in addition to differences in lengths of follow-up [33]. In the current study, an additional, immediate increase of 0.81 mmol/mol (0.08%) was detected at the time of the policy change in the current study.…”

Section: Discussionsupporting

confidence: 51%

“…It should be noted that all the patients included in our study were diagnosed with T2D at least 1 year before the start of the follow-up of HbA1c development and at least 4 years before the policy change in Jan, 2017. In addition, according to our previous study, younger patients with T2D were poorly monitored compared with the older patients in the North Karelia region [33]. Furthermore, we did not have information on patients using private health care services.…”

Section: Discussionmentioning

confidence: 97%

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Impact of co-payment level increase of antidiabetic medications on glycaemic control: an interrupted time-series study among Finnish patients with type 2 diabetes

Lavikainen

Aarnio

Jalkanen

et al. 2020

BMC Health Serv Res

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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.

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Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 97%

Impact of co-payment level increase of antidiabetic medications on glycaemic control: an interrupted time-series study among Finnish patients with type 2 diabetes

Lavikainen

Aarnio

Jalkanen

et al. 2020

BMC Health Serv Res

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“…Successful change requires new roles and responsibilities, and willingness among healthcare professionals to co-work and co-learn [ 34 , 35 ]. In Siun sote, the quality improvement of type 2 diabetes care has been active, and the quality of type 2 diabetes care at the primary-health care level has been shown to be very good [ 36 ], but there is always room for improvement.…”

Section: Discussionmentioning

confidence: 99%

The effect of the integration of health services on health care usage among patients with type 2 diabetes in North Karelia, Finland

Wikström

Lamidi

Rautiainen

et al. 2021

BMC Health Serv Res

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Background The need to improve the care of people with complex care requirements has been driving the reforms integrating care processes. This study examines the effect of the integration of health services on health care usage and the processes and outcomes of care among type 2 diabetes patients. Methods Data include all type 2 diabetes patients who lived in North Karelia, Finland, between 2014 and 2018. Health care contacts and glycated haemoglobin (HbA1c) measurements were obtained from the electronic health records. Logistic, Poisson and linear models with generalised estimating equations and the Friedman test were used to study the differences between years. Results The health care usage was highest in 2017, the first year of a new organisation, and smallest in the following year. Before the new organisation, the health care usage was lowest in 2014, being slightly higher compared with 2018. Between the last two years, the mean number of contacts per person declined from 3.25 to 2.88 (-0.37, p < 0.001). The decreasing pattern seen in total health care usage was most obvious among contacts with primary health care nurses. The number of contacts increased only among specialised care nurses between the last two years. The number of HbA1c measurements was also in its lowest in 2018 but in its highest in 2015. Between the years 2014 and 2018, the difference in the mean number of contacts was − 0.05 (p = 0.011) for those not measured, -0.02 (p = 0.225) for those measured and within the target level of HbA1c, and 0.12 (p = 0.001) for those measured and not at the target level of HbA1c. Conclusions Health care integration first increased the health care usage but then brought it to a slightly lower level than before. The changes were most obvious in primary health care nurses’ appointments, and no decline was observed in secondary-level care. Even though the numbers of HbA1c measurements and the proportion measured declined, measurements increased among those with poor glycaemic control. The observed changes might reflect the better targeting and more concordant services in different service units.

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“…In North Karelia, the amount of statin prescriptions for type 2 diabetes patients increased more among men than women during the follow-up period, and this might at least partly explain the lower levels of LDL values for men. In general, the achievements of LDL targets were moderately good and our previous study showed that 59% of women and 66% of men achieved the recommended level of LDL (≤2.5 mmol/l) in 2015–2016 [ 42 ]. In addition, a subgroup analysis of type 2 diabetes patients with CVD indicated that 22% of women and 32% of men achieved the LDL target < 1.8 mmol/l.…”

Section: Discussionmentioning

confidence: 99%

Trends in the process and outcome indicators of type 2 diabetes care: a cohort study from Eastern Finland, 2012–2017

et al. 2020

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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.

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Maintenance of good glycaemic control is challenging – A cohort study of type 2 diabetes patient in North Karelia, Finland

Cited by 9 publications

References 30 publications

Impact of co-payment level increase of antidiabetic medications on glycaemic control: an interrupted time-series study among Finnish patients with type 2 diabetes

Impact of co-payment level increase of antidiabetic medications on glycaemic control: an interrupted time-series study among Finnish patients with type 2 diabetes

The effect of the integration of health services on health care usage among patients with type 2 diabetes in North Karelia, Finland

Trends in the process and outcome indicators of type 2 diabetes care: a cohort study from Eastern Finland, 2012–2017

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