Care trajectories are associated with quality improvement in the treatment of patients with uncontrolled type 2 diabetes: A registry based cohort study
(2015) Primary Care Diabetes — Vol. 9, n° 5, p. 354-361 (2015)
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- Aims To analyse whether care trajectories (CT) were associated with increased prevalence of parenteral hypoglycemic treatment (PHT = insulin or GLP-1 analogues), statin therapy or RAAS-inhibition. Introduced in 2009 in Belgium, CTs target patients with type 2 diabetes mellitus (T2DM), in need for or with PHT. Methods Retrospective study based on a registry with 97 general practitioners. The evolution in treatment since 2006 was compared between patients with vs. without a CT, using longitudinal logistic regression. Results Comparing patients with (N = 271) vs. without a CT (N = 4424), we noted significant differences (p < 0.05) in diabetes duration (10.1 vs. 7.3 years), HbA1c (7.5 vs. 6.9%), LDL-C (85 vs. 98 mg/dl), microvascular complications (26 vs. 16%). Moreover, in 2006, parenteral treatment (OR 52.1), statins (OR 4.1) and RAAS-inhibition (OR 9.6) were significantly more prevalent (p < 0.001). Between 2006 and 2011, the prevalence rose in both groups regarding all three treatments, but rose significantly faster (p < 0.05) after 2009 in the CT-group. Conclusions Patients enrolled in a CT differ from other patients even before the start of this initiative with more intense hypoglycemic and cardiovascular treatment. Yet, they presented higher HbA1c-levels and more complications. Enrolment in a CT is associated with additional treatment intensification
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Goderis, G., Van Casteren, V., De Clercq, E., Bossuyt, N., Van Den Broeke, C., Vanthomme, K., Moreels, S., Nobels, F., Mathieu, C., & Buntinx, F. (2015). Care trajectories are associated with quality improvement in the treatment of patients with uncontrolled type 2 diabetes: A registry based cohort study. Primary Care Diabetes, 9(5), 354-361. https://doi.org/10.1016/j.pcd.2015.01.008 (Original work published 2015)