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      Control of Glycemia and Cardiovascular Risk Factors in Patients With Type 2 Diabetes in Primary Care in Catalonia (Spain)

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          Abstract

          OBJECTIVE

          The objective of this study was to analyze the clinical characteristics and levels of glycemic and cardiovascular risk factor control in patients with type 2 diabetes that are in primary health care centers in Catalonia (Spain).

          RESEARCH DESIGN AND METHODS

          This was a cross-sectional study of a total population of 3,755,038 individuals aged 31–90 years at the end of 2009. Clinical data were obtained retrospectively from electronic clinical records.

          RESULTS

          A total of 286,791 patients with type 2 diabetes were identified (7.6%). Fifty-four percent were men, mean (SD) age was 68.2 (11.4) years, and mean duration of disease was 6.5 (5.1) years. The mean (SD) A1C value was 7.15 (1.5)%, and 56% of the patients had A1C values ≤7%. The mean (SD) blood pressure (BP) values were 137.2 (13.8)/76.4 (8.3) mmHg, mean total cholesterol concentration was 192 (38.6) mg/dL, mean HDL cholesterol concentration was 49.3 (13.2) mg/dL, mean LDL cholesterol (LDL-C) concentration was 112.5 (32.4) mg/dL, and mean BMI was 29.6 (5) kg/m 2. Thirty-one percent of the patients had BP values ≤130/80 mmHg, 37.9% had LDL-C values ≤100 mg/dL, and 45.4% had BMI values ≤30 kg/m 2. Twenty-two percent were managed exclusively with lifestyle changes. Regarding medicated diabetic patients, 46.9, 22.9, and 2.8% were prescribed one, two, or three antidiabetic drugs, respectively, and 23.4% received insulin therapy.

          CONCLUSIONS

          The results from this study indicate a similar or improved control of glycemia, lipids, and BP in patients with type 2 diabetes when compared with previous studies performed in Spain and elsewhere.

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          Most cited references15

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          Improvements in diabetes processes of care and intermediate outcomes: United States, 1988-2002.

          Jinan B Saaddine, Betsy L. Cadwell, Edward Gregg … (2006)
          Progress of diabetes care is a subject of public health concern. To assess changes in quality of diabetes care in the United States by using standardized measures. National population-based, serial cross-sectional surveys. National Health and Nutrition Examination Survey (1988-1994 and 1999-2002) and the Behavioral Risk Factor Surveillance System (1995 and 2002). Survey participants 18 to 75 years of age who reported a diagnosis of diabetes. Glycemic control, blood pressure, low-density lipoprotein (LDL) cholesterol level, annual cholesterol level monitoring, and annual foot and dilated eye examination, as defined by the National Diabetes Quality Improvement Alliance measures. In the past decade, the proportion of persons with diabetes with poor glycemic control (hemoglobin A1c > 9%) showed a nonstatistically significant decrease of 3.9% (95% CI, -10.4% to 2.5%), while the proportion of persons with fair or good lipid control (LDL cholesterol level < 3.4 mmol/L [<130 mg/dL]) had a statistically significant increase of 21.9% (CI, 12.4% to 31.3%). Mean LDL cholesterol level decreased by 0.5 mmol/L (18.8 mg/dL). Although mean hemoglobin A1c did not change, the proportion of persons with hemoglobin A(1c) of 6% to 8% increased from 34.2% to 47.0%. The blood pressure distribution did not change. Annual lipid testing, dilated eye examination, and foot examination increased by 8.3% (CI, 4.0% to 12.7%), 4.5% (CI, 0.5% to 8.5%), and 3.8% (CI, -0.1% to 7.7%), respectively. The proportion of persons reporting annual influenza vaccination and aspirin use improved by 6.8 percentage points (CI, 2.9 percentage points to 10.7 percentage points) and 13.1 percentage points (CI, 5.4 percentage points to 20.7 percentage points), respectively. Data are self-reported, and the surveys do not have all National Diabetes Quality Improvement Alliance indicators. Diabetes processes of care and intermediate outcomes have improved nationally in the past decade. But 2 in 5 persons with diabetes still have poor LDL cholesterol control, 1 in 3 persons still has poor blood pressure control, and 1 in 5 persons still has poor glycemic control.
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            Evaluation of risk factors for development of complications in Type II diabetes in Europe.

            A Liebl, M. Mata, E Eschwege (2002)
            The Cost of Diabetes in Europe - Type II study is the first large coordinated attempt to measure the current standard of care and determine the costs of managing patients with Type II (non-insulin-dependent) diabetes mellitus. The study evaluated glycaemic control, blood lipid levels and blood pressure, all of which are risk factors for complications. Records of these clinical characteristics were collected from over 7000 patients during the 6-month study period. The mean HbA(1c) value for the entire study population was 7.5%, ranging from 7.0% in Sweden to 7.8% in the United Kingdom. Only 31% of individuals achieved good glycaemic control (HbA(1c)< or = 6.5%) according to current European guidelines. Only 64% of the total study population were tested for HbA(1c) values at least once within the 6-month study period (ranging from 49% in Spain to 71% in the UK), although HbA(1c) testing every 3 months is recommended for all patients, by European Diabetes Policy Group guidelines. The majority of patients had borderline total cholesterol values, with a mean value of 5.7 mmol/l. Overall, 21% of patients were classified as having low risk cholesterol levels (<4.8 mmol/l). Good triglyceride levels (<1.7 mmol/l) were achieved by 47% of the total study population. During the study period, 81% of patients had their blood pressure measured, with 35% and 53.3% of the patients reaching the recommended targets for systolic and diastolic blood pressure, respectively. This study showed that a high proportion of patients with risk factors for diabetes-related complications are not adequately controlled. Improvements in disease management and monitoring are therefore required to ensure that guideline targets are met, thus reducing the long-term complications of Type II diabetes.
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              The diabetes audit and research in Tayside Scotland (DARTS) study: electronic record linkage to create a diabetes register. DARTS/MEMO Collaboration.

              R MacAlpine, A.-B. Morris, Charles Newton … (1997)
              To identify all patients with diabetes in a community using electronic record linkage of multiple data sources and to compare this method of case ascertainment with registers of diabetic patients derived from primary care. Electronic capture-recapture linkage of records included data on all patients attending hospital diabetes clinics, all encashed prescriptions for diabetes related drugs and monitoring equipment, all patients discharged from hospital, patients attending a mobile unit for eye screening, and results for glycated haemoglobin and plasma glucose concentrations from the regional biochemistry database. Diabetes registers from primary care were from a random sample of eight Tayside general practices. A detailed manual study of relevant records for the 35,144 patients registered with these eight general practices allowed for validation of the case ascertainment. Tayside region of Scotland, population 391,274 on 1 January 1996. Prevalence of diabetes; population of patients identified by different data sources; sensitivity and positive predictive value of ascertainment methods. Electronic record linkage identified 7596 diabetic patients, giving a prevalence of known diabetes of 1.94% (0.21% insulin dependent diabetes, 1.73% non-insulin dependent): 63% of patients had attended hospital diabetes clinics, 68% had encashed diabetes related prescriptions, 72% had attended the mobile eye screening unit, and 48% had biochemical results diagnostic of diabetes. A further 701 patients had isolated hyperglycaemia (plasma glucose > 11.1 mmol/l) but were not considered diabetic by general practitioners. Validation against the eight general practices (636 diabetic patients) showed electronic linkage to have a sensitivity of 0.96 and a positive predictive value of 0.95 for ascertainment of known diabetes. General practice lists had a sensitivity of 0.91 and a positive predictive value of 0.98. Electronic record linkage was more sensitive than general practice registers in identifying diabetic subjects and identified an additional 0.18% of the population with a history of hyperglycaemia who might warrant screening for undiagnosed diabetes.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Diabetes Care
                Journal ID (iso-abbrev): Diabetes Care
                Journal ID (hwp): diacare
                Journal ID (pmc): dcare
                Journal ID (publisher-id): Diabetes Care
                Title: Diabetes Care
                Publisher: American Diabetes Association
                ISSN (Print): 0149-5992
                ISSN (Electronic): 1935-5548
                Publication date (Print): April 2012
                Publication date (Electronic): 13 March 2012
                Volume: 35
                Issue: 4
                Pages: 774-779
                Affiliations
                [1] 1Department of Endocrinology and Nutrition, Diabetes Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
                [2] 2Primary Care Center La Mina, Gerencia d’Ambit d’Atencio Primaria Barcelona Ciutat, Institut Catala de la Salut, Barcelona, Spain
                [3] 3Institut Universitari d’Investigacio en Atencio Primaria Jordi Gol, Barcelona, Spain
                [4] 4Universitat Autònoma de Barcelona, Barcelona, Spain
                [5] 5Institut Catala de la Salut, Barcelona, Spain
                [6] 6Public Health Management Agency, Generalitat de Catalunya Health Department, Barcelona, Spain
                [7] 7Primary Care Center Raval, Gerencia d’Ambit d’Atencio Primaria Barcelona Ciutat, Institut Catala de la Salut, Barcelona, Spain
                [8] 8Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Lleida, Spain
                [9] 9Institut de Recerca Biomedica de Lleida, University of Lleida, Lleida, Spain
                Author notes
                Corresponding author: Didac Mauricio, didacmauricio@ 123456gmail.com .
                Article
                Publisher ID: 1679
                DOI: 10.2337/dc11-1679
                PMC ID: 3308283
                PubMed ID: 22344609
                SO-VID: 158928aa-866e-48d4-a811-90236cee4d0a
                Copyright © © 2012 by the American Diabetes Association.
                License:

                Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

                History
                Date received : 31 August 2011
                Date accepted : 27 December 2011
                Categories
                Subject: Original Research
                Subject: Epidemiology/Health Services Research

                ScienceOpen disciplines: Endocrinology & Diabetes
                Data availability:
                ScienceOpen disciplines: Endocrinology & Diabetes

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