Quality of Care of People With Type 2 Diabetes in Eight European Countries

Abstract

OBJECTIVEWe sought to determine levels of adherence in eight European countries to recommendations for the management of type 2 diabetes and to investigate factors associated with key intermediate outcomes.RESEARCH DESIGN AND METHODSGUIDANCE was a cross-sectional study including retrospective data extraction from the medical records of people with type 2 diabetes recruited, using a shared protocol, from primary and specialist care sites in the following eight European countries: Belgium, France, Germany, Italy, Ireland, Sweden, the Netherlands, and the United Kingdom. The dataset for analysis comprised 7,597 cases. Proportions meeting process and outcome criteria were determined, including between-country variations. Logistic regression was used to investigate potential predictors of meeting targets for HbA1c, blood pressure, and LDL cholesterol.RESULTSIn the total sample, adherence to process recommendations was high for some measures, for example, HbA1c recorded in past 12 months in 97.6% of cases. Target achievement for intermediate outcome measures was lower, with only 53.6% having HbA1c <7%. Considerable between-country variation was identified for both processes and outcomes. The following characteristics were associated with an increased likelihood of meeting targets for all three measures considered (HbA1c, blood pressure, LDL cholesterol): shorter diagnosis of diabetes; having one or more macrovascular complications; lower BMI; being prescribed lipid-lowering medication; and no current antihypertensive prescribing.CONCLUSIONSCompared with earlier reports, we have suggested some encouraging positive trends in Europe in relation to meeting targets for the management of people with type 2 diabetes, but there is still scope for further improvement and greater between-country consistency.

Blood Pressure Control in an 11-Year Cohort of Diabetic and Non-Diabetic Individuals with Hypertension

“…Higher control rates were found in South Korea, 66.3% [9], followed by Canada, 53.6% [8], the United States, 51.1% [10], and South Africa, 45.8% [11]. In contrast, the control rates in Italy and Ireland are below 25.0% [12] and are similar to those found in the present study. According to several studies conducted in different countries, patients with hypertension and DM achieve a better BP control when the goals are set to 130/80 mmHg than when these values are higher [13][14][15].…”

Clinical inertia in the management of type 2 diabetes mellitus: a focused literature review

“…A recent study of eight European countries emphasised how there is still room for further improvement in meeting targets, with only 53.6% of people with type 2 diabetes achieving HbA1c <7% (53 mmol/mol), and only 6.5% of the cohort meeting all three targets for HbA1c, LDL-cholesterol, and blood pressure. 3 The Position Statement proposed jointly by the ADA and EASD recommends individualised targets based on various factors, including patient preferences, needs and values, co-morbidities, duration of diabetes, risk of hypoglycaemia, costs and, overall, ensuring a patient-centred approach. 4 It also recommends stringent HbA1c targets of 6-6.5% (42-47.5 mmol/mol) in newlydiagnosed patients.…”

A Multicenter Italian Survey on Diabetes Care Units Reveals a Somewhat Slow Attitude in Treatment Guideline Implementation: Are We Dealing With Therapeutic Inertia?

“…The reasons why too many patients are still far from reaching acceptable glucose levels all over Europe 16,17 may include poor care system organization, as reported above, but also patients poor adherence to treatment. 18 In fact, according to a meta-analysis of 127 studies which reported a significantly higher adherence rate for people handled by communication-trained physicians, patients adherence is also affected by clinicians communication skills.…”