Metabolic control and morbidity of Type 2 diabetic patients in a general practice network

Bouma, Margriet; Dekker, Janny H.; Eijk, Jtm van; Schellevis, F.G.; Kriegsman, Dmw; Heine, R.J.

doi:10.1093/fampra/16.4.402

Cited by 31 publications

(28 citation statements)

References 18 publications

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“…With this procedure it seems plausible that under-representation of patients non-compliant to medical care was limited. The prevalence of diabetes, mean age, sex, glycaemic control, treatment of patients, and the known duration of the disease were comparable to other recent investigations in general practice [10][11][12]. Thus, it is highly likely that our findings were representative of general practice in The Netherlands.…”

Section: Discussionsupporting

confidence: 85%

Patient Characteristics do not Predict Poor Glycaemic Control in type 2 Diabetes Patients Treated in Primary Care

et al. 2003

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Abstract. Many diabetic patients in general practice do not achieve good glycaemic control. The aim of this study was to assess which characteristics of type 2 diabetes patients treated in primary care predict poor glycaemic control (HbA 1c P 7%). Data were collected from the medical records. 1641 patients were included who had mean HbA 1c 7.1(SD 1.7)% , and 42% had HbA 1c P 7%. On univariate analysis younger age; longer duration of diabetes; higher levels of blood glucose at diagnosis; most recent fasting blood glucose (FBG), total cholesterol, and triglyceride; higher body mass index (BMI); treatment with oral hypoglycaemic agents (OHA); treatment with insulin; more GP-visits for diabetes in the last year; and lower educational level were associated with poor control. Both in multiple linear regression and in multiple logistic regression higher levels of FBG (odds ratio (OR): = 1.6, 95% confidence interval (CI): 1.49, 1.70), treatment with OHA (OR: 2.1, 95% CI: 1.41, 3.04), treatment with insulin (OR: 7.2, 95% CI: 4.18, 12.52), lower educational level (OR: 1.26, 95% CI: 1.01, 1.56) were independently associated with poor levels of HbA 1c . When FBG levels were excluded from the model, higher blood glucose at diagnosis, higher values for triglyceride and total cholesterol, and younger age predicted poor glycaemic control, but these variables explained only 15% of the variation in HbA 1c . In conclusion prediction of poor glycaemic control from patient characteristics in diabetic patients in general practice is hardly possible. FBG appeared to be a strong predictor of HbA 1c , which underlines the usefulness of this simple test in daily diabetes care. The worse metabolic control in those treated with either OHA or insulin suggests that current treatment regimes might be not sufficiently applied to reach the targets of care. Providers of diabetes care should be attentive to patients with lower educational level.

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Section: Discussionsupporting

confidence: 85%

Patient Characteristics do not Predict Poor Glycaemic Control in type 2 Diabetes Patients Treated in Primary Care

et al. 2003

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“…Compliance with guidelines by GPs has been described as reasonable to less than optimal. [25][26][27] Features of primary health care teams associated with successful quality improvement of care for patients with DM have also been reported. 8 Personal involvement, good teamwork, a positive attitude to monitoring of care and recognizing the need for systematic plans to address obstacles to quality improvement are hallmarks of quality improvement.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment of hypertension and other cardiovascular risk factors in patients with DM may be even more important than managing blood glucose levels and GlyHb A1c . 26,[30][31][32][33] The impact of lifestyle and the potential for change is equally important. [34][35][36] Different approaches between countries in attempting to modify lifestyle have not been assessed in this study.…”

Section: Discussionmentioning

confidence: 99%

Differences in treatment regimes, consultation frequency and referral patterns of diabetes mellitus in general practice in five European countries

Donker

Fleming²,

Schellevis³

et al. 2004

Family Practice

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Donker GA, Fleming DM, Schellevis FG and Spreeuwenberg P. Differences in treatment regimes, consultation frequency and referral patterns of diabetes mellitus in general practice in five European countries. Family Practice 2004; 21: 364-369.Background. In many European countries, maturity onset diabetes mellitus (DM) is to a large extent managed in general practice. Objective. Our aim was to compare management of DM in general practice in five European countries in order to contribute to international guidelines on the management of DM by GPs. Methods.Routine monitoring of patients presenting with DM was performed during a 12 month period (1999)(2000) to GPs in established sentinel practice surveillance networks in five European countries (Belgium, Croatia, England, Spain and The Netherlands). Results were stratified by age and country.Results. The proportion of patients treated by diet only varied from 13% (The Netherlands) to 25% (Spain); diet and oral antidiabetics from 51% (England) to 62% (Belgium); a combination of diet and insulin varied from 15% (Belgium and Croatia) to 26% (The Netherlands); and a combination of diet, oral antidiabetics and insulin was Ͻ10% in all countries. In the older age groups, insulin is prescribed most frequently in The Netherlands. Spain and Croatia show high consultation rates for DM; England and The Netherlands show low rates. Referral percentages vary considerably between countries (highest in Croatia).Conclusions. National differences found included the use of insulin in the elderly, the consultation frequency in general practice and the referral rate to ophthalmologist and diabetic specialists. Further quantitative and qualitative studies are needed to explore the needs for support in diabetes management in general practice in Europe.

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“…Auf der Grundlage einer Literaturrecherche zu aktuellen evidenzbasierten Leitlinien der Behandlung von Diabetes Mellitus [22] …”

Section: Erstentwurfunclassified

Das Diabetes-Ampelschema - Entwicklung eines Instruments für das hausärztliche Case Management bei Patienten mit Diabetes mellitus

Chmiel

Birnbaum

Gensichen

et al. 2011

Praxis

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In order to sustain the continuity and quality of treatment in diabetic primary care patients, it is necessary to introduce structured and regularly performed monitoring system into the practice team. The monitoring aims at early and valid recognition of potential complications resulting from a chronic disease. Ideally the practice nurse is in charge of the case management. The central element of the case management is a colour coded instrument, the diabetes traffic light scheme, by which means the most important clinical parameters and patient adherence can be screened in regular intervals. Additionally, the instrument regulates in-practice communication by means of stratified action plans and enables ideal treatment continuity also in larger teams. The experiences resulting from the development of this diabetes-specific traffic light scheme can be beneficial for the future development of similar instruments in other chronic diseases.

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Metabolic control and morbidity of Type 2 diabetic patients in a general practice network

Abstract: The care for Type 2 diabetic patients needs improvement and should focus on cardiovascular risk factors as much as on glycaemic control.

Cited by 31 publications

References 18 publications

Patient Characteristics do not Predict Poor Glycaemic Control in type 2 Diabetes Patients Treated in Primary Care

Patient Characteristics do not Predict Poor Glycaemic Control in type 2 Diabetes Patients Treated in Primary Care

Differences in treatment regimes, consultation frequency and referral patterns of diabetes mellitus in general practice in five European countries

Das Diabetes-Ampelschema - Entwicklung eines Instruments für das hausärztliche Case Management bei Patienten mit Diabetes mellitus

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