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de Haan-Du J, Groenier KH, Wauben-Spaetgens B, Jalving M, Kleefstra N, Landman GWD, de Bock GH. The Value of Glycemic Control Prior to Cancer Diagnosis on All-Cause Mortality among Patients with Type 2 Diabetes in Dutch Primary Care. Cancer Epidemiol Biomarkers Prev 2023; 32:252-259. [PMID: 36442479 PMCID: PMC9900319 DOI: 10.1158/1055-9965.epi-22-0766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/19/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Poor glycemic control prior to cancer diagnosis for patients with preexisting type 2 diabetes (T2DM) may predict a worse cancer diagnosis. We investigated the association between pre-diagnosis glycemic control and all-cause mortality in patients with T2DM who develop cancer. METHODS This prospective cohort study linked data from three sources covering 1989 to 2019: a T2DM benchmarking database, the Netherlands Cancer Registry, and the Personal Records Database. We included patients with T2DM and incident primary breast, colorectal, or prostate cancer (stage 0-III), with target glycemic control defined according to Dutch guidelines. Analysis involved estimating the association between glycemic control and all-cause mortality with Cox proportional hazard models, accounting for individual expected survival relative to the general population and relevant disease (e.g., diabetes duration and medications) and individual (e.g., age and gender) characteristics. RESULTS Of the 71,648 linked cases, 620 had breast cancer, 774 had colorectal cancer, and 438 had prostate cancer, with follow-up data available for 6.4 (4.2-8.4), 5.6 (2.7-7.6), and 6.3 (4.5-8.2) years, respectively. Compared with patients with pre-diagnosis glycemic control at target, the HRs and 95% confidence intervals for mortality among those with pre-diagnosis glycemic control not at target were 1.40 (1.00-1.96) for breast cancer, 1.45 (1.12-1.88) for colorectal cancer, and 1.39 (0.98-1.98) for prostate cancer. CONCLUSIONS Among patients with T2DM in Dutch primary care, poor glycemic control before diagnosis with breast and colorectal cancer can increase mortality compared with good control. IMPACT Glycemic control prior to cancer diagnosis is of prognostic value.
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Affiliation(s)
- Jing de Haan-Du
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | | | - Brendy Wauben-Spaetgens
- Department of Research and Development, Netherlands Comprehensive Cancer organization (IKNL), Utrecht, the Netherlands
| | - Mathilde Jalving
- Department of Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Nanne Kleefstra
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands.,GGZ Drenthe Mental Health Institute, Department of Forensic Psychiatry, Assen, the Netherlands
| | - Gijs W D Landman
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands.,Department of Internal Medicine, Gelre Hospital, Apeldoorn, the Netherlands
| | - Geertruida H de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
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2
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Ambrož M, de Vries ST, Hoogenberg K, Denig P. Less Timely Initiation of Glucose-Lowering Medication Among Younger and Male Patients With Diabetes and Similar Initiation of Blood Pressure-Lowering Medication Across Age and Sex: Trends Between 2015 and 2020. Front Pharmacol 2022; 13:883103. [PMID: 35645811 PMCID: PMC9133603 DOI: 10.3389/fphar.2022.883103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/13/2022] [Indexed: 11/15/2022] Open
Abstract
Aims: We aimed to assess trends in glycosylated hemoglobin A1c (HbA1c) and systolic blood pressure (SBP) thresholds at initiation of glucose- and blood pressure-lowering medication among patients with type 2 diabetes and assess the influence of age and sex on these trends. Materials and Methods: We used the Groningen Initiative to ANalyze Type 2 diabetes Treatment (GIANTT) primary care database. Patients initiating a first non-insulin glucose-lowering or any blood pressure-lowering medication between 2015 and 2020 with an HbA1c or SBP measurement in the 120 days before initiation were included. We used multilevel regression analyses adjusted for potential confounders to assess the influence of calendar year, age or sex, and the interaction between calendar year and age or sex on trends in HbA1c and SBP thresholds at initiation of medication. Results: We included 2,671 and 2,128 patients in the analyses of HbA1c and SBP thresholds, respectively. The overall mean HbA1c threshold at initiation of glucose-lowering medication significantly increased from 7.4% in 2015 to 8.0% in 2020 (p < 0.001), and particularly in the younger age groups. Compared to patients ≥80 years, patients aged 60–69 years initiated medication at lower levels mainly in the early years. Patients <60 years and between 70–79 years initiated medication at similar levels as patients ≥80 years. Females initiated medication at lower levels than males throughout the study period (p < 0.001). The mean SBP threshold at initiation of blood pressure-lowering medication varied from 145 to 149 mmHg without a clear trend (p = 0.676). There were no differences in SBP thresholds between patients of different ages or sex. Conclusion: The rising trend in the HbA1c threshold for initiating glucose-lowering medication in the lower age groups was unexpected and requires further investigation. Males appear to receive less timely initiation of glucose-lowering medication than females. The lack of higher thresholds for the oldest age group or lower thresholds for the youngest age group in recent years is not in line with the age-related recommendations for personalized diabetes care and calls for health systems interventions.
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Affiliation(s)
- Martina Ambrož
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Sieta T. de Vries
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Klaas Hoogenberg
- Department of Internal Medicine, Martini Hospital, Groningen, Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- *Correspondence: Petra Denig,
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3
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Mevissen MRJ, Geurten RJ, Hendriks SH, Elissen A, van Dijk PR, Bilo HJG. Distribution of care expenditures for men and women with type 2 diabetes treated in primary care in the Netherlands: a case-control study (ZODIAC-59). BMJ Open 2022; 12:e052592. [PMID: 35190426 PMCID: PMC8860008 DOI: 10.1136/bmjopen-2021-052592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study aims to provide insight into the distribution of care expenditures for patients with type 2 diabetes mellitus (T2DM)- across multiple healthcare service categories and medical specialties-who receive diabetes care in the primary care setting. DESIGN Observational, matched case-control study. SETTING In the Netherlands, T2DM-specific care is mainly provided in the primary care setting. However, many patients with T2DM also use secondary care for complications and comorbidities, either related or unrelated to their diabetes. PARTICIPANTS Patients with T2DM receiving diabetes care in primary care and participating in the Dutch Zwolle Outpatient Diabetes project Integrating Available Care cohort in the year 2011 were matched to persons without T2DM. Matching (1:2 ratio) was performed based on age, gender and socioeconomic status. Clinical data were combined with an all-payer claims database from 2011. RESULTS In total, 43 775 patients with T2DM were identified of whom 37 240 could be matched with 74 480 controls. Total secondary care expenditures were €94 705 814, with a total annual median expenditure per patient of €2133 (1161 to 3340) for men and €2,535 (1374 to 5105) for women. The largest share of expenditures was on medication (26%), followed by secondary care (23%) and primary care services related (23%) to T2DM. The five most expensive specialties were: cardiology, surgery, internal medicine, orthopaedics and ophthalmology. Care expenditures for T2DM patients were twofold higher than those for persons without T2DM. Healthcare expenditures showed a skewed distribution, indicating that a small part of the studied population is responsible for a considerable part of the costs. CONCLUSIONS Expenditures among primary care treated T2DM patients are higher than non-diabetic matched controls. Medication is the largest share of T2DM care expenditures. The present study provides insights into healthcare expenditures for T2DM; this may enable more efficient healthcare planning and reimbursement.
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Affiliation(s)
- M R J Mevissen
- Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rose Julie Geurten
- Health Services Research, Maastricht University, Maastricht, Limburg, The Netherlands
| | | | - Arianne Elissen
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Peter Ruben van Dijk
- Endocrinology, University of Groningen Faculty of Medical Sciences, Groningen, The Netherlands
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henk J G Bilo
- Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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4
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van Bruggen S, Kasteleyn MJ, Rauh SP, Meijer JS, Busch KJG, Numans ME, Chavannes NH. Experiences with tailoring of primary diabetes care in well-organised general practices: a mixed-methods study. BMC Health Serv Res 2021; 21:1218. [PMID: 34753463 PMCID: PMC8577855 DOI: 10.1186/s12913-021-07198-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/24/2021] [Indexed: 11/21/2022] Open
Abstract
Background Dutch standard diabetes care is generally protocol-driven. However, considering that general practices wish to tailor diabetes care to individual patients and encourage self-management, particularly in light of current COVID-19 related constraints, protocols and other barriers may hinder implementation. The impact of dispensing with protocol and implementation of self-management interventions on patient monitoring and experiences are not known. This study aims to evaluate tailoring of care by understanding experiences of well-organised practices 1) when dispensing with protocol; 2) determining the key conditions for successful implementation of self-management interventions; and furthermore exploring patients’ experiences regarding dispensing with protocol and self-management interventions. Methods in this mixed-methods prospective study, practices (n = 49) were invited to participate if they met protocol-related quality targets, and their adult patients with well-controlled type 2 diabetes were invited if they had received protocol-based diabetes care for a minimum of 1 year. For practices, study participation consisted of the opportunity to deliver protocol-free diabetes care, with selection and implementation of self-management interventions. For patients, study participation provided exposure to protocol-free diabetes care and self-management interventions. Qualitative outcomes (practices: 5 focus groups, 2 individual interviews) included experiences of dispensing with protocol and the implementation process of self-management interventions, operationalised as implementation fidelity. Quantitative outcomes (patients: routine registry data, surveys) consisted of diabetes monitoring completeness, satisfaction, wellbeing and health status at baseline and follow-up (24 months). Results Qualitative:
In participating practices (n = 4), dispensing with protocol encouraged reflection on tailored care and selection of various self-management interventions A focus on patient preferences, team collaboration and intervention feasibility was associated with high implementation fidelity
Quantitative:
In patients (n = 126), likelihood of complete monitoring decreased significantly after two years (OR 0.2 (95% CI 0.1–0.5), p < 0.001) Satisfaction decreased slightly (− 1.6 (95% CI -2.6;-0.6), p = 0.001) Non-significant declines were found in wellbeing (− 1.3 (95% CI -5.4; 2.9), p = 0.55) and health status (− 3.0 (95% CI -7.1; 1.2), p = 0.16).
Conclusions To tailor diabetes care to individual patients within well-organised practices, we recommend dispensing with protocol while maintaining one structural annual monitoring consultation, combined with the well-supported implementation of feasible self-management interventions. Interventions should be selected and delivered with the involvement of patients and should involve population preferences and solid team collaborations. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07198-2.
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Affiliation(s)
- Sytske van Bruggen
- Department of Public Health and Primary Care, Leiden University Medical Center, room V6.26, Postbus 9600 2300, RC, Leiden, The Netherlands. .,Hadoks (Elzha), President Kennedylaan 15, 2517, JK, The Hague, The Netherlands.
| | - Marise J Kasteleyn
- Department of Public Health and Primary Care, Leiden University Medical Center, room V6.26, Postbus 9600 2300, RC, Leiden, The Netherlands
| | - Simone P Rauh
- Dept of Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam. De Boelelaan 1089a, 1081, HV, Amsterdam, The Netherlands
| | - Julia S Meijer
- HSK Group, President Kennedylaan 19, 2517, JK, The Hague, The Netherlands
| | - Karin J G Busch
- Hadoks (Elzha), President Kennedylaan 15, 2517, JK, The Hague, The Netherlands
| | - Mattijs E Numans
- Department of Public Health and Primary Care, Leiden University Medical Center, room V6.26, Postbus 9600 2300, RC, Leiden, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, room V6.26, Postbus 9600 2300, RC, Leiden, The Netherlands
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5
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de Haan-Du J, Landman GWD, Groenier KH, Vissers PAJ, Louwman MWJ, Kleefstra N, de Bock GH. The Risk of Cutaneous Squamous Cell Carcinoma Among Patients with Type 2 Diabetes Receiving Hydrochlorothiazide: A Cohort Study. Cancer Epidemiol Biomarkers Prev 2021; 30:2114-2121. [PMID: 34493493 DOI: 10.1158/1055-9965.epi-21-0620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/05/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Because of continuous hyperglycemia and hyperinsulinemia and the use of photosensitizing drug, hydrochlorothiazide (HCTZ), the risk of cutaneous squamous cell carcinoma (cSCC) might be increased among patients with diabetes. This study aimed to estimate the risk of cSCC among HCTZ users with type 2 diabetes, and to determine whether thiazide-like diuretics, another drug in the same class with HCTZ, would be safer. METHODS We linked the benchmarking database in Dutch primary care, the Netherlands Cancer Registry, and the Dutch Personal Records Database (1998-2019). All 71,648 patients were included, except for those who had a history of skin cancer prior to cohort entry. We used Cox modeling to estimate the HRs and 95% confidence intervals for cSCC. The model was adjusted by cumulative exposure to each antihypertensive, age, sex, smoking, body mass index, blood pressure, serum creatinine, other confounding drug use at cohort entry, and cohort entry year. RESULTS There were 1,409 cSCC events (23 among thiazide-like diuretics users), during a follow-up of 679,789 person-years. Compared with no HCTZ use, the adjusted HRs for HCTZ use were 1.18 (1.00-1.40) for ≤2 years, 1.57 (1.32-1.88) for 2 to 4 years, and 2.09 (1.73-2.52) for >4 years. The HR was 0.90 (0.79-1.03) for an additional year of thiazide-like diuretic use. CONCLUSIONS In patients with diabetes, exposure to HCTZ for >2 years is associated with an increased risk of cSCC, whereas no increased risk associated with thiazide-like diuretics was observed. IMPACT The potential increased risk of cSCC should be a consideration when prescribing HCTZ, with thiazide-like diuretics offering a safer alternative.
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Affiliation(s)
- Jing de Haan-Du
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Gijs W D Landman
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Internal Medicine, Gelre Hospital, Apeldoorn, the Netherlands.,Langerhans Medical Research Group, Ommen, the Netherlands
| | | | - Pauline A J Vissers
- Department of Research and development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Marieke W J Louwman
- Department of Research and development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Nanne Kleefstra
- Langerhans Medical Research Group, Ommen, the Netherlands.,Department of Internal Medicine, Groningen, University of Groningen, University Medical Center Groningen, the Netherlands.,Department of Forensic Psychiatry, GGZ Drenthe Mental Health Institute, Assen, the Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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6
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de Haan-Du J, Landman GWD, Kleefstra N, Schrijnders D, Manders M, Bos ACRK, Tromp-van Driel C, Denig P, Groenier KH, de Bock GH. Glycemic Control for Colorectal Cancer Survivors Compared to Those without Cancer in the Dutch Primary Care for Type 2 Diabetes: A Prospective Cohort Study. Cancers (Basel) 2021; 13:cancers13112767. [PMID: 34199595 PMCID: PMC8199666 DOI: 10.3390/cancers13112767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/26/2021] [Accepted: 05/29/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary A growing number of colorectal cancer survivors live with type 2 diabetes, as a result of improved cancer diagnosis and treatment. These patients might have worse glycemic control after their cancer diagnosis, which may increase the risk of cardiovascular diseases. This prospective cohort study evaluated the quality of glycemic control for colorectal cancer survivors, as compared to those without cancer in Dutch primary care for diabetes. During a 10-year follow-up for 57,330 patients, there were 705 patients diagnosed with colorectal cancer. No clinically relevant difference on the probability of reaching the target HbA1c was observed between colorectal cancer survivors and patients with no history of cancer. These results showed a robust diabetes care system, implying that the glycemic control for colorectal cancer survivors can be delegated to the primary care professionals. Abstract Cancer survivors with diabetes tend to have worse glycemic control after their cancer diagnosis, which may increase the risk of cardiovascular diseases. We aimed to investigate whether glycemic control differs between colorectal cancer (CRC) survivors and those without cancer, among patients with type 2 diabetes being treated in the Dutch primary care. The Zwolle Outpatient Diabetes project Integrating Available Care database was linked with the Dutch Cancer Registry (n = 71,648, 1998–2014). The cases were those with stage 0–III CRC, and the controls were those without cancer history. The primary and secondary outcomes were the probability of reaching the glycated hemoglobin (HbA1c) target and the mean of HbA1c during follow-up, respectively. Mixed linear modeling was applied, where the status of CRC was a time-varying variable. Among the 57,330 patients included, 705 developed CRC during follow-up. The mean probability of reaching the HbA1c target during follow-up was 73% versus 74% (p = 0.157) for CRC survivors versus those without cancer, respectively. The mean HbA1c was 51.1 versus 50.8 mmol/mol (p = 0.045) among CRC survivors versus those without cancer, respectively. We observed a clinically comparable glycemic control among the CRC survivors without cancer, indicating that glycemic control for CRC survivors can be delegated to primary care professionals.
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Affiliation(s)
- Jing de Haan-Du
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (G.W.D.L.); (G.H.d.B.)
- Correspondence: ; Tel.: +31-(050)-361-0739
| | - Gijs W. D. Landman
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (G.W.D.L.); (G.H.d.B.)
- Langerhans Medical Research Group, 7731 AT Ommen, The Netherlands; (N.K.); (D.S.); (M.M.)
- Department of Internal Medicine, Gelre Hospital, 7334 DZ Apeldoorn, The Netherlands
| | - Nanne Kleefstra
- Langerhans Medical Research Group, 7731 AT Ommen, The Netherlands; (N.K.); (D.S.); (M.M.)
- Department of Forensic Psychiatry, GGZ Drenthe Mental Health Institute, 9404 LA Assen, The Netherlands
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Dennis Schrijnders
- Langerhans Medical Research Group, 7731 AT Ommen, The Netherlands; (N.K.); (D.S.); (M.M.)
| | - Marjolijn Manders
- Langerhans Medical Research Group, 7731 AT Ommen, The Netherlands; (N.K.); (D.S.); (M.M.)
| | - Amanda C. R. K. Bos
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), 3511 DT Utrecht, The Netherlands;
| | | | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | | | - Geertruida H. de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (G.W.D.L.); (G.H.d.B.)
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7
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Ambrož M, de Vries ST, Sidorenkov G, Hoogenberg K, Denig P. Changes in blood pressure thresholds for initiating antihypertensive medication in patients with diabetes: a repeated cross-sectional study focusing on the impact of age and frailty. BMJ Open 2020; 10:e037694. [PMID: 32912988 PMCID: PMC7485238 DOI: 10.1136/bmjopen-2020-037694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To assess trends in systolic blood pressure (SBP) thresholds at initiation of antihypertensive treatment in patients with type 2 diabetes and the impact of age and frailty on these trends. STUDY DESIGN AND SETTING A repeated cross-sectional cohort study (2007-2014) using the Groningen Initiative to Analyse Type 2 diabetes Treatment database was conducted. The influence of calendar year, age or frailty and the interaction between year and age or frailty on SBP thresholds were assessed using multilevel regression analyses adjusted for potential confounders. RESULTS We included 4819 patients. The mean SBP at treatment initiation was 157 mm Hg in 2007, rising to 158 mm Hg in 2009 and decreasing to 151 mm Hg in 2014. This quadratic trend was significant (p<0.001). Older patients initiated treatment at higher SBP, but similar decreasing trends after 2009 were observed in all age groups. There were no significant differences in SBP thresholds between patients with different frailty groups. The association between year and SBP threshold was not influenced by age or frailty. CONCLUSION After an initial rise, the observed SBP thresholds decreased over time and were not influenced by age or frailty. This is in contrast with changed guideline recommendations towards more personalised treatment during the study period and illustrates that changing prescribing practice may take considerable time. Patient-specific algorithms and tools focusing on when and when not to initiate treatment could be helpful to support personalised diabetes care.
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Affiliation(s)
- Martina Ambrož
- University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Sieta T de Vries
- University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Grigory Sidorenkov
- University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Petra Denig
- University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
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8
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Du J, Kleefstra N, Schrijnders D, Groenier KH, de Bock GH, Landman GWD. Is Gliclazide Associated with a Lower Obesity-Related Cancer Risk Compared to Other Sulfonylureas? A Long-term Prospective Cohort Study. Cancer Epidemiol Biomarkers Prev 2020; 29:1596-1605. [PMID: 32404443 DOI: 10.1158/1055-9965.epi-19-1517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/08/2020] [Accepted: 05/05/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Gliclazide has been suspected to be associated with a lower obesity-related cancer risk; however, current evidence is limited by important methodologic shortcomings. This study aimed to evaluate whether gliclazide is preferred over other sulfonylureas regarding obesity-related cancer risk. METHODS In this prospective cohort study, an annual benchmarking database in Dutch primary care (Zwolle Outpatient Diabetes project Integrating Available CareZODIAC, 1998-2014) was linked to the Netherlands Cancer Registry and the Dutch Personal Record Database. Of the 71,648 patients with type 2 diabetes, we included 26,207 who used sulfonylureas and had no history of cancer or insulin use at baseline. Obesity-related cancer was defined using the latest definition of the World Cancer Research Fund. Cox regression analyses were used to estimate HRs, with both baseline sulfonylurea and cumulative exposure modeled and corrected for baseline covariates. RESULTS During follow-up for 167,692 person-years, there were 1,111 obesity-related cancer events. For males, the adjusted HRs [95% confidence interval (CI)] for baseline sulfonylurea compared with gliclazide were as follows: glibenclamide, 1.10 (0.92-2.69); glimepiride, 1.13 (0.68-1.84); and tolbutamide, 0.93 (0.59-1.48). For females, these were as follows: glibenclamide, 1.49 (0.72-3.13); glimepiride, 0.96 (0.59-1.54); and tolbutamide, 0.84 (0.54-1.28). The adjusted HRs (95% CI) for one more year of cumulative exposure compared with gliclazide were as follows: glibenclamide, 0.90 (0.71-1.14); glimepiride, 0.96 (0.87-1.06); and tolbutamide, 1.00 (0.92-1.09). For females, these were as follows: glibenclamide, 0.93 (0.77-1.13); glimepiride, 0.99 (0.90-1.10); and tolbutamide, 1.04 (0.96-1.13). CONCLUSIONS Obesity-related cancer risk was comparable between gliclazide and other sulfonylureas. IMPACT Gliclazide is not preferred over other sulfonylureas regarding obesity-related cancer risk.
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Affiliation(s)
- Jing Du
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Nanno Kleefstra
- Langerhans Medical Research Group, Ommen, the Netherlands
- GGZ Drenthe Mental Health Institute, High and Intensive Care, Assen, the Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | | | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gijs W D Landman
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Langerhans Medical Research Group, Ommen, the Netherlands
- Department of Internal Medicine, Gelre Hospital, Apeldoorn, the Netherlands
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9
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van Bruggen S, Rauh SP, Bonten TN, Chavannes NH, Numans ME, Kasteleyn MJ. Association between GP participation in a primary care group and monitoring of biomedical and lifestyle target indicators in people with type 2 diabetes: a cohort study (ELZHA cohort-1). BMJ Open 2020; 10:e033085. [PMID: 32345697 PMCID: PMC7213889 DOI: 10.1136/bmjopen-2019-033085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Whether care group participation by general practitioners improves delivery of diabetes care is unknown. Using 'monitoring of biomedical and lifestyle target indicators as recommended by professional guidelines' as an operationalisation for quality of care, we explored whether (1) in new practices monitoring as recommended improved a year after initial care group participation (aim 1); (2) new practices and experienced practices differed regarding monitoring (aim 2). DESIGN Observational, real-life cohort study. SETTING Primary care registry data from Eerstelijns Zorggroep Haaglanden (ELZHA) care group. PARTICIPANTS Aim 1: From six new practices (n=538 people with diabetes) that joined care group ELZHA in January 2014, two practices (n=211 people) were excluded because of missing baseline data; four practices (n=182 people) were included. Aim 2: From all six new practices (n=538 people), 295 individuals were included. From 145 experienced practices (n=21 465 people), 13 744 individuals were included. EXPOSURE Care group participation includes support by staff nurses on protocolised diabetes care implementation and availability of a system providing individual monitoring information. 'Monitoring as recommended' represented minimally one annual registration of each biomedical (HbA1c, systolic blood pressure, low-density lipoprotein) and lifestyle-related target indicator (body mass index, smoking behaviour, physical exercise). PRIMARY OUTCOME MEASURES Aim 1: In new practices, odds of people being monitored as recommended in 2014 were compared with baseline (2013). Aim 2: Odds of monitoring as recommended in new and experienced practices in 2014 were compared. RESULTS Aim 1: After 1-year care group participation, odds of being monitored as recommended increased threefold (OR 3.00, 95% CI 1.84 to 4.88, p<0.001). Aim 2: Compared with new practices, no significant differences in the odds of monitoring as recommended were found in experienced practices (OR 1.21, 95% CI 0.18 to 8.37, p=0.844). CONCLUSIONS We observed a sharp increase concerning biomedical and lifestyle monitoring as recommended after 1-year care group participation, and subsequently no significant difference between new and experienced practices-indicating that providing diabetes care within a collective approach rapidly improves registration of care.
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Affiliation(s)
- Sytske van Bruggen
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Chronical Care, Hadoks, The Hague, The Netherlands
| | - Simone P Rauh
- Department of Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tobias N Bonten
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Niels H Chavannes
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Mattijs E Numans
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Marise J Kasteleyn
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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10
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Vos RC, den Ouden H, Daamen LA, Bilo HJG, Denig P, Rutten GEHM. Population-based screen-detected type 2 diabetes mellitus is associated with less need for insulin therapy after 10 years. BMJ Open Diabetes Res Care 2020; 8:8/1/e000949. [PMID: 32238363 PMCID: PMC7170393 DOI: 10.1136/bmjdrc-2019-000949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/10/2020] [Accepted: 02/07/2020] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION With increased duration of type 2 diabetes, most people have a growing need of glucose-lowering medication and eventually might require insulin. Presumptive evidence is reported that early detection (eg, by population-based screening) and treatment of hyperglycemia will postpone the indication for insulin treatment. A treatment legacy effect of population-based screening for type 2 diabetes of about 3 years is estimated. Therefore, we aim to compare insulin prescription and glycemic control in people with screen-detected type 2 diabetes after 10 years with data from people diagnosed with type 2 diabetes seven (treatment legacy effect) and 10 years before during care-as-usual. RESEARCH DESIGN AND METHODS Three cohorts were compared: one screen-detected cohort with 10 years diabetes duration (Anglo-Danish-Dutch study of Intensive Treatment in People with Screen-Detected Diabetes in Primary care (ADDITION-NL): n=391) and two care-as-usual cohorts, one with 7-year diabetes duration (Groningen Initiative to Analyze Type 2 Diabetes Treatment (GIANTT) and Zwolle Outpatient Diabetes project Integrating Available Care (ZODIAC): n=4473) and one with 10-year diabetes duration (GIANTT and ZODIAC: n=2660). Insulin prescription (primary outcome) and hemoglobin A1c (HbA1c) of people with a known diabetes duration of 7 years or 10 years at the index year 2014 were compared using regression analyses. RESULTS Insulin was prescribed in 10.5% (10-year screen detection), 14.7% (7-year care-as-usual) and 19.0% (10-year care-as-usual). People in the 7-year and 10-year care-as-usual groups had a 1.5 (95% CI 1.0 to 2.1) and 1.8 (95% CI 1.3 to 2.7) higher adjusted odds for getting insulin prescribed than those after screen detection. Lower HbA1c values were found 10 years after screen detection (mean 50.1 mmol/mol (6.7%) vs 51.8 mmol/mol (6.9%) and 52.8 mmol/mol (7.0%)), compared with 7 years and 10 years after care-as-usual (MDadjusted: 1.6 mmol/mol (95% CI 0.6 to 2.6); 0.1% (95% CI 0.1 to 0.2) and 1.8 mmol/mol (95% CI 0.7 to 2.9); and 0.2% (95% CI 0.1 to 0.3)). CONCLUSION Population-based screen-detected type 2 diabetes is associated with less need for insulin after 10 years compared with people diagnosed during care-as-usual. Glycemic control was better after screen detection but on average good in all groups.
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Affiliation(s)
- Rimke C Vos
- Public Health and Primary Care/LUMC-Campus The Hague, LUMC, Leiden, The Netherlands
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Henk den Ouden
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Lois A Daamen
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Henk J G Bilo
- Department of Internal Medicine, Isala Klinieken Locatie Weezenlanden, Zwolle, The Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, UMCG, Groningen, The Netherlands
| | - Guy E H M Rutten
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
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11
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Nagaraj SB, Sidorenkov G, van Boven JFM, Denig P. Predicting short- and long-term glycated haemoglobin response after insulin initiation in patients with type 2 diabetes mellitus using machine-learning algorithms. Diabetes Obes Metab 2019; 21:2704-2711. [PMID: 31453664 PMCID: PMC6899933 DOI: 10.1111/dom.13860] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/30/2019] [Accepted: 08/20/2019] [Indexed: 01/04/2023]
Abstract
AIM To assess the potential of supervised machine-learning techniques to identify clinical variables for predicting short-term and long-term glycated haemoglobin (HbA1c) response after insulin treatment initiation in patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS We included patients with T2DM from the Groningen Initiative to Analyse Type 2 diabetes Treatment (GIANTT) database who started insulin treatment between 2007 and 2013 and had a minimum follow-up of 2 years. Short- and long-term responses at 6 (±2) and 24 (±2) months after insulin initiation, respectively, were assessed. Patients were defined as good responders if they had a decrease in HbA1c ≥ 5 mmol/mol or reached the recommended level of HbA1c ≤ 53 mmol/mol. Twenty-four baseline clinical variables were used for the analysis and an elastic net regularization technique was used for variable selection. The performance of three traditional machine-learning algorithms was compared for the prediction of short- and long-term responses and the area under the receiver-operating characteristic curve (AUC) was used to assess the performance of the prediction models. RESULTS The elastic net regularization-based generalized linear model, which included baseline HbA1c and estimated glomerular filtration rate, correctly classified short- and long-term HbA1c response after treatment initiation, with AUCs of 0.80 (95% CI 0.78-0.83) and 0.81 (95% CI 0.79-0.84), respectively, and outperformed the other machine-learning algorithms. Using baseline HbA1c alone, an AUC = 0.71 (95% CI 0.65-0.73) and 0.72 (95% CI 0.66-0.75) was obtained for predicting short-term and long-term response, respectively. CONCLUSIONS Machine-learning algorithm performed well in the prediction of an individual's short-term and long-term HbA1c response using baseline clinical variables.
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Affiliation(s)
- Sunil B. Nagaraj
- Department of Clinical Pharmacy and Pharmacology, University of GroningenUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Grigory Sidorenkov
- Department of Clinical Pharmacy and Pharmacology, University of GroningenUniversity Medical Centre GroningenGroningenThe Netherlands
- Department of Epidemiology, University of GroningenUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Job F. M. van Boven
- Department of Clinical Pharmacy and Pharmacology, University of GroningenUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University of GroningenUniversity Medical Centre GroningenGroningenThe Netherlands
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12
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Metwally AM, Soliman M, Abdelmohsen AM, Kandeel WA, Saber M, Elmosalami DM, Asem N, Fathy AM. Effect of Counteracting Lifestyle Barriers through Health Education in Egyptian Type 2 Diabetic Patients. Open Access Maced J Med Sci 2019; 7:2886-2894. [PMID: 31844454 PMCID: PMC6901843 DOI: 10.3889/oamjms.2019.624] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Egypt is among the world top 10 countries in diabetes prevalence. It is the first country among the MENA region. Healthy lifestyle education and support help people with diabetes to improve health outcomes. Many physical and psychological barriers can hinder patients from following a healthy lifestyle. AIM This study aimed to examine the effect of lifestyle modification educational sessions in helping Egyptian patients to overcome main barriers of diabetes self-management through improving nutritional behaviours, physical activity, medication compliance, and blood glucose monitoring. METHODS A cohort study included 205 patients with type 2 diabetes. Baseline assessment of patients' lifestyle behaviours and barriers using personal diabetes questionnaire of Louisville University, with both anthropometric and blood glucose assessment. Interventional lifestyle health education was provided weekly through multiple integrated techniques, followed by a post-intervention assessment to evaluate the effect of the health education sessions. Statistical analysis was done to identify any statistically significant difference before and after the health education intervention. RESULTS There was a significant improvement of the post-education mean scores of the studied behaviours when compared with the pre-education scores of the participants' behaviours (p < 0.001). There was also a significant reduction in the barriers facing patients to diabetes self-management including nutritional barriers (P < 0.001), medication compliance barriers (P < 0.001) with a percent change (43%), physical activity barriers (p < 0.001), and blood glucose monitoring (p < 0.001) with a percent change (44%).There was a statistically significant positive correlation between improvement of medication compliance (P = 0.027), blood glucose monitoring(P = 0.045), and glycated haemoglobin of the study participants. CONCLUSION lifestyle modification education of type 2 diabetic patients can overcome the main barriers of following a healthy lifestyle and improve their anthropometric measures and blood glucose level.
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Affiliation(s)
- Ammal Mokhtar Metwally
- Department of Community Medicine Research, Medical Division, National Research Centre, Giza, Egypt
| | - Mona Soliman
- Department of Public Health & Community Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Aida M. Abdelmohsen
- Department of Community Medicine Research, Medical Division, National Research Centre, Giza, Egypt
| | - Wafaa A. Kandeel
- Biological Anthropology Department, Medical Division, National Research Centre, Giza, Egypt
- Theodor Bilharz Research Institute, Giza, Egypt
| | - Maha Saber
- Department of Complementary Medicine Research, Medical Division, National Research Centre, Giza, Egypt
- Medical Research Centre of Excellence (MRCE), Giza, Egypt
| | - Dalia Mohamed Elmosalami
- Department of Community Medicine Research, Medical Division, National Research Centre, Giza, Egypt
| | - Noha Asem
- Department of Public Health & Community Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Asmaa Mohamed Fathy
- Department of Community Medicine Research, Medical Division, National Research Centre, Giza, Egypt
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13
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Riordan F, McHugh SM, Harkins V, Marsden P, Kearney PM. Sustaining quality in the community: trends in the performance of a structured diabetes care programme in primary care over 16 years. Diabet Med 2018; 35:1078-1086. [PMID: 29706032 DOI: 10.1111/dme.13658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2018] [Indexed: 11/28/2022]
Abstract
AIM To examine the quality of care delivered by a structured primary care-led programme for people with Type 2 diabetes mellitus in 1999-2016. METHODS The Midland Diabetes Structured Care Programme provides structured primary care-led management. Trends over time in care processes were examined (using a chi-squared trend test and age- and gender-adjusted logistic regression). Screening and annual review attendance were reviewed. A composite of eight National Institute for Health and Care Excellence-recommended processes was used as a quality indicator. Participants who were referred to diabetes nurse specialists were compared with those not referred (Student's t-test, Pearson's chi-squared test, Wilcoxon-Mann-Whitney test). Proportions achieving outcome targets [HbA1c ≤58 mmol/mol (7.5%), blood pressure ≤140/80 mmHg, cholesterol <5.0 mmol/l] were calculated. RESULTS Data were available for people with diabetes aged ≥18 years: 1998/1999 (n=336); 2003 (n=843); 2008 (n=988); and 2016 (n=1029). Recording of some processes improved significantly over time (HbA1c , cholesterol, blood pressure, creatinine), and in 2016 exceeded 97%. Foot assessment and annual review attendance declined. In 2016, only 29% of participants had all eight National Institute for Health and Care Excellence processes recorded. A higher proportion of people with diabetes who were referred to a diabetes nurse specialist had poor glycaemic control compared with those not referred. The proportions meeting blood pressure and lipid targets increased over time. CONCLUSIONS Structured primary care led to improvements in the quality of care over time. Poorer recording of some processes, a decline in annual review attendance, and participants remaining at high risk suggest limits to what structured care alone can achieve. Engagement in continuous quality improvement to target other factors, including attendance and self-management, may deliver further improvements.
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Affiliation(s)
- F Riordan
- School of Public Health, University College Cork, Cork, Ireland
| | - S M McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - V Harkins
- Midland Diabetes Structured Care Programme, Offaly, Ireland
| | - P Marsden
- Child Health Screening Programmes, Health and Wellbeing Division, Department of Public Health, HSE Area Office, Offaly, Ireland
| | - P M Kearney
- School of Public Health, University College Cork, Cork, Ireland
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14
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Sidorenkov G, van Boven JFM, Hoekstra T, Nijpels G, Hoogenberg K, Denig P. HbA1c response after insulin initiation in patients with type 2 diabetes mellitus in real life practice: Identifying distinct subgroups. Diabetes Obes Metab 2018; 20:1957-1964. [PMID: 29687577 PMCID: PMC6055847 DOI: 10.1111/dom.13332] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/06/2018] [Accepted: 04/19/2018] [Indexed: 12/30/2022]
Abstract
AIMS To identify subgroups of patients with type 2 diabetes mellitus (T2DM) following distinct trajectories of HbA1c after insulin initiation and explore underlying differences in clinical characteristics. MATERIALS AND METHODS A cohort study was conducted in patients with T2DM initiating insulin in 2007-2013 with a follow-up of 2 to 4 years. Data were collected from the Groningen Initiative to Analyze Type 2 Diabetes Treatment (GIANTT) database. The primary outcome was subgroups with different trajectories of HbA1c patterns after insulin initiation, as identified by latent class growth modeling. Differences between subgroups were tested using one-way ANOVA, Kruskal-Wallis or chi-square tests, where appropriate. RESULTS From 1459 patients, three subgroups with distinct HbA1c patterns were identified. Group 1 (8%) initially showed a moderate decrease followed by an increase in HbA1c 2 years later, despite receiving more comedication. Group 2 (84%) showed a stable decrease. Group 3 (8%) had a high initial level of HbA1c and a rapid decline within the first year, followed by a slow increase thereafter. Group 1 patients were on average 6-7 years younger than patients in groups 2 and 3 and were more likely to receive sulfonylureas than Group 3 patients. Group 3 patients had a shorter diabetes duration and were less well-controlled for HbA1c, systolic blood pressure and LDL-cholesterol at insulin initiation. CONCLUSIONS Most patients showed a stable HbA1c response, but one out of six patients showed either a poor response, or a rapid initial response only after insulin initiation. Response patterns were associated with age, diabetes duration and risk-factor controls at the time of insulin initiation.
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Affiliation(s)
- Grigory Sidorenkov
- Department of Clinical Pharmacy and PharmacologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
- Department of EpidemiologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Job F. M. van Boven
- Department of Clinical Pharmacy and PharmacologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Trynke Hoekstra
- Center for Human Movement SciencesUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
- Department of Health Sciences, Faculty of ScienceAmsterdam Public Health Research Institute, VU University Medical CenterAmsterdamThe Netherlands
| | - Giel Nijpels
- Department of General Practice and Elderly Care MedicineAmsterdam Public Health Research Institute, VU University Medical CenterAmsterdamThe Netherlands
| | - Klaas Hoogenberg
- Department of Internal MedicineMartini HospitalGroningenThe Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and PharmacologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
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15
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Russell‐Jones D, Pouwer F, Khunti K. Identification of barriers to insulin therapy and approaches to overcoming them. Diabetes Obes Metab 2018; 20:488-496. [PMID: 29053215 PMCID: PMC5836933 DOI: 10.1111/dom.13132] [Citation(s) in RCA: 163] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/28/2017] [Accepted: 10/14/2017] [Indexed: 12/15/2022]
Abstract
Poor glycaemic control in type 2 diabetes (T2D) is a global problem despite the availability of numerous glucose-lowering therapies and clear guidelines for T2D management. Tackling clinical or therapeutic inertia, where the person with diabetes and/or their healthcare providers do not intensify treatment regimens despite this being appropriate, is key to improving patients' long-term outcomes. This gap between best practice and current level of care is most pronounced when considering insulin regimens, with studies showing that insulin initiation/intensification is frequently and inappropriately delayed for several years. Patient- and physician-related factors both contribute to this resistance at the stages of insulin initiation, titration and intensification, impeding achievement of optimal glycaemic control. The present review evaluates the evidence and reasons for this delay, together with available methods for facilitation of insulin initiation or intensification.
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Affiliation(s)
- David Russell‐Jones
- Department of Diabetes and EndocrinologyRoyal Surrey County Hospital NHS Foundation TrustGuildfordUK
| | - Frans Pouwer
- Department of PsychologyUniversity of Southern DenmarkOdenseDenmark
| | - Kamlesh Khunti
- College of Medicine, Biological Sciences and Psychology, Leicester Diabetes CentreUniversity of LeicesterUK
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16
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Schrijnders D, Hendriks SH, Kleefstra N, Vissers PAJ, Johnson JA, de Bock GH, Bilo HJG, Landman GWD. Sex differences in obesity related cancer incidence in relation to type 2 diabetes diagnosis (ZODIAC-49). PLoS One 2018; 13:e0190870. [PMID: 29370205 PMCID: PMC5784905 DOI: 10.1371/journal.pone.0190870] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 12/21/2017] [Indexed: 12/20/2022] Open
Abstract
Background Diabetes and obesity seem to be partly overlapping risk factors for the development of obesity-related cancer (mainly breast, prostate and colorectal cancer) in patients with type 2 diabetes (T2DM). In the general population, women have a lower risk for obesity-related cancer compared to men. Previous studies involving cardiovascular disease have shown that T2DM eliminates a female advantage of lower CVD risk in the general population compared to men. It is unclear whether the same could be true for obesity-related cancer. This study aimed to this investigate obesity-related cancer incidence in women and men known with T2DM as compared to the Dutch general population. Methods This study included 69,583 patients with T2DM selected from a prospective primary care cohort, which was linked to the Dutch National Cancer Registry to obtain cancer specific data. Obesity-related cancers included liver, kidney, colorectal, gallbladder, pancreas, ovarian, endometrial, advanced prostate cancer, post-menopausal breast cancer and oesophageal adenocarcinoma. Primary outcome was sex-stratified, age and year of cancer diagnosis adjusted standardized incidence ratios (SIRs) for three time periods: 5 years before, the year after diagnosis and the next 4 years after T2DM diagnosis. The Dutch general population was used as reference group. Results Women with T2DM were at an increased risk for obesity-related cancer compared to women in the general population already 5 years before diabetes diagnosis (SIR 1.77; 95%CI: 1.63–1.91). In both men and women, there was a peak in obesity-related cancer incidence following diabetes diagnosis (SIR: 1.38; 95%CI 1.11–1.64 and SIR: 2.21; 95%CI 1.94–2.30, respectively). From the second to the fifth year after diabetes diagnosis the obesity-related cancer incidence was higher in women compared to women in the general population (SIR: 2.12; 95%CI 1.94–2.30). Conclusions Women with T2DM seem to have a substantially higher obesity-related cancer risk. As opposed to men, in women this risk was already increased years before diabetes diagnosis. These results could imply that a relative advantage of women in the general population with regard to cancer risk is lost in women with T2DM.
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Affiliation(s)
- Dennis Schrijnders
- Langerhans Medical Research Group, Zwolle, the Netherlands
- Diabetes Centre, Zwolle, the Netherlands
- * E-mail:
| | | | - Nanne Kleefstra
- Langerhans Medical Research Group, Zwolle, the Netherlands
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands
| | | | | | - Geertruida H. de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Henk J. G. Bilo
- Diabetes Centre, Zwolle, the Netherlands
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands
- Department of Internal Medicine, Zwolle, the Netherlands
| | - Gijs W. D. Landman
- Langerhans Medical Research Group, Zwolle, the Netherlands
- Department of Internal Medicine, Gelre Hospital, Apeldoorn, the Netherlands
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17
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Hendriks SH, van Hateren KJJ, Groenier KH, Landman GWD, Maas AHEM, Bilo HJG, Kleefstra N. Sex differences in survival of patients with type 2 diabetes in primary care (ZODIAC-50). BMJ Open 2017; 7:e015870. [PMID: 29074510 PMCID: PMC5665232 DOI: 10.1136/bmjopen-2017-015870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To investigate sex differences in survival of primary care treated patients with type 2 diabetes (T2D) in the Netherlands. SETTING Primary care. PARTICIPANTS A total of 1815 patients who participated in a prospective observational cohort study (Zwolle Outpatient Diabetes Project Integrating Available Care (ZODIAC)) were included of which 56% was female. Inclusion took place in 1998, 1999 and 2001. Vital status was assessed in 2013. MAIN OUTCOME MEASURE Relative survival of men and women with T2D. The relative survival rate was expressed as the ratio of observed survival of patients divided by the survival of the general population in the Netherlands with comparable age. RESULTS After 14 years, 888 (49%) patients had died. The relative survival rate was 0.88 (0.81-0.94) for men and 0.82 (0.76-0.87) for women with T2D after 14 years (p value for difference between sexes=0.169). In patients without a history of cardiovascular diseases (CVD), the relative survival was 0.99 (0.94-1.05) in men and 0.92 (0.87-0.97) in women (p value for difference between sexes=0.046). CONCLUSIONS The survival of men and women with T2D was 12% and 18% lower, respectively, after 14 years of follow-up compared with men and women in the general population. This corresponds to a decrease in median survival of 2.2 and 3.5 years in men and women, respectively. Only for patients with T2D without a history of CVD, a significantly lower relative survival in women compared with men with T2D was found.
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Affiliation(s)
| | | | - Klaas H Groenier
- Department of General Practice, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Gijs W D Landman
- Langerhans Medical Research Group, Zwolle, The Netherlands
- Department of Internal Medicine, Gelre hospital, Apeldoorn, The Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henk J G Bilo
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
- Department of Internal Medicine, Isala, Zwolle, The Netherlands
| | - Nanne Kleefstra
- Langerhans Medical Research Group, Zwolle, The Netherlands
- Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
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18
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Schrijnders D, de Bock GH, Houweling ST, van Hateren KJJ, Groenier KH, Johnson JA, Bilo HJG, Kleefstra N, Landman GWD. Within-class differences in cancer risk for sulfonylurea treatments in patients with type 2 diabetes (ZODIAC-55) - a study protocol. BMC Cancer 2017. [PMID: 28645260 PMCID: PMC5482962 DOI: 10.1186/s12885-017-3433-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background Patients with type 2 diabetes (T2D) are at increased risk for developing cancer. As approximately 8% of the world’s population is living with T2D, even a slight increase in cancer risk could result in an enormous impact on the number of persons developing cancer. In addition, several glucose lowering drug classes for treating patients with T2D have been associated with a difference in risk of cancer overall, and especially for obesity related cancers. In what way and to what degree cancer risk is modified by the use of different sulfonylureas (SU) is unclear. The primary aim of this study will be to evaluate within-class SU differences in obesity related cancer risk. Secondary aims will be to investigate within-class SU differences in risk for all cancers combined and site-specific cancers separately (i.e. breast, colorectal, prostate, bladder and lung cancer) and to account for duration-response relationships between individual SU use and cancer risk. Methods Patients will be selected from a Dutch primary care cohort of patients with T2D linked with the Dutch Cancer Registration (ZODIAC-NCR). Within this cohort study annually collected clinical data (e.g. blood pressure, weight, HbA1c) and nationwide data on cancer incidence are available. Time-dependent cox proportional hazard analyses will be performed to evaluate SU cancer risk, adjusted for potential confounders. Discussion This study will be the first prospective cohort study investigating within-class SU differences in cancer risk and could contribute to improved decision making regarding the individual drugs within the class of SUs, and possibly improve quality of life and result in an increased cost-effectiveness of healthcare in patients with T2D. Trial registration Nederlands Trialregister (NTR6166), 6 Jan 2017.
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Affiliation(s)
- Dennis Schrijnders
- Diabetes Centre, Isala, P.O. Box 10400, 8000 GK, Zwolle, the Netherlands. .,Langerhans Medical Research Group, Zwolle, the Netherlands.
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | | | - Klaas H Groenier
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Henk J G Bilo
- Diabetes Centre, Isala, P.O. Box 10400, 8000 GK, Zwolle, the Netherlands.,Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Internal Medicine, Isala, Zwolle, the Netherlands
| | - Nanne Kleefstra
- Langerhans Medical Research Group, Zwolle, the Netherlands.,Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gijs W D Landman
- Langerhans Medical Research Group, Zwolle, the Netherlands.,Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Internal Medicine, Gelre Hospital, Apeldoorn, the Netherlands
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19
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Smits KPJ, Sidorenkov G, Kleefstra N, Bouma M, Meulepas M, Voorham J, Navis G, Bilo HJG, Denig P. Development and validation of prescribing quality indicators for patients with type 2 diabetes. Int J Clin Pract 2017; 71. [PMID: 27981681 DOI: 10.1111/ijcp.12922] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/19/2016] [Indexed: 11/30/2022] Open
Abstract
AIM Quality indicators are used to measure whether healthcare professionals act according to guidelines, but few indicators focus on the quality of pharmacotherapy for diabetes. The aim of this study was to develop and validate a set of prescribing quality indicators (PQIs) for type 2 diabetes in primary care, and to apply this set in practice. To take into account the stepwise treatment of chronic disease, clinical action indicators were specifically considered. METHODS Potential PQIs were derived from clinical practice guidelines and evaluated using the RAND/UCLA Appropriateness Method, a modified Delphi panel. Thereafter, the feasibility of calculating the PQIs was tested in two large Dutch primary care databases including >80 000 diabetes patients in 2012. RESULTS 32 PQIs focusing on treatment with glucose, lipid, blood pressure and albuminuria lowering drugs, and on vaccination, medication safety and adherence were assessed by ten experts. After the Delphi panel, the final list of twenty PQIs was tested for feasibility. All PQIs definitions were feasible for measuring the quality of medication treatment using these databases. Indicator scores ranged from 18.8% to 90.8% for PQIs focusing on current medication use, clinical action and medication choice, and from 2.1% to 37.2% for PQIs focusing on medication safety. DISCUSSION AND CONCLUSIONS Twenty PQIs focusing on treatment with glucose, lipid, blood pressure and albuminuria lowering drugs, and on medication safety in type 2 diabetes were developed, considered valid and operationally feasible. Results showed room for improvement, especially in initiation and intensification of treatment as measured with clinical action indicators.
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Affiliation(s)
- Kirsten P J Smits
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Grigory Sidorenkov
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nanno Kleefstra
- Langerhans Medical Research Group, Zwolle, The Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Margriet Bouma
- Dutch College of General Practitioners (NHG), Utrecht, The Netherlands
| | - Marianne Meulepas
- Dutch Institute for Rational Use of Medicine (IVM), Utrecht, The Netherlands
| | - Jaco Voorham
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerjan Navis
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henk J G Bilo
- Diabetes Centre, Isala Clinics, Zwolle, The Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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20
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Cho YY, Sidorenkov G, Denig P. Role of Patient and Practice Characteristics in Variance of Treatment Quality in Type 2 Diabetes between General Practices. PLoS One 2016; 11:e0166012. [PMID: 27806107 PMCID: PMC5091743 DOI: 10.1371/journal.pone.0166012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 10/21/2016] [Indexed: 11/18/2022] Open
Abstract
Background Accounting for justifiable variance is important for fair comparisons of treatment quality. The variance between general practices in treatment quality of type 2 diabetes (T2DM) patients may be attributed to the underlying patient population and practice characteristics. The objective of this study is to describe the between practice differences in treatment, and identify patient and practice level characteristics that may explain these differences. Methods The data of 24,607 T2DM patients from 183 general practices in the Netherlands were used. Treatment variance was assessed in a cross-sectional manner for: glucose-lowering drugs/metformin, lipid-lowering drugs/statins, blood pressure-lowering drugs/ACE-inhibitor or ARB. Patient characteristics tested were age, gender, diabetes duration, comorbidity, comedication. Practice characteristics were number of T2DM patients, practice type, diabetes assistant available. Multilevel logistic regression was used to examine the between practice variance in treatment and the effect of characteristics on this variance. Results Treatment rates varied considerably between practices (IQR 9.5–13.9). The variance at practice level was 7.5% for glucose-lowering drugs, 3.6% for metformin, 3.1% for lipid-lowering drugs, 10.3% for statins, 8.6% for blood pressure-lowering drugs, and 3.9% for ACE-inhibitor/ARB. Patient and practice characteristics explained 19.0%, 7.5%, 20%, 6%, 9.9%, and 13.4% of the variance respectively. Age, multiple chronic drugs, and ≥3 glucose-lowering drugs were the most relevant patient characteristics. Number of T2DM patients per practice was the most relevant practice characteristic. Discussion Considerable differences exist between practices in treatment rates. Patients’ age was identified as characteristic that may account for justifiable differences in especially lipid-lowering treatment. Other patient or practice characteristics either do not explain or do not justify the differences.
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Affiliation(s)
- Yeon Young Cho
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Epidemiology, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Grigory Sidorenkov
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- * E-mail:
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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21
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Laxy M, Knoll G, Schunk M, Meisinger C, Huth C, Holle R. Quality of Diabetes Care in Germany Improved from 2000 to 2007 to 2014, but Improvements Diminished since 2007. Evidence from the Population-Based KORA Studies. PLoS One 2016; 11:e0164704. [PMID: 27749939 PMCID: PMC5066975 DOI: 10.1371/journal.pone.0164704] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 09/29/2016] [Indexed: 11/23/2022] Open
Abstract
Objective Little is known about the development of the quality of diabetes care in Germany. The aim of this study is to analyze time trends in patient self-management, physician-delivered care, medication, risk factor control, complications and quality of life from 2000 to 2014. Methods Analyses are based on data from individuals with type 2 diabetes of the population-based KORA S4 (1999–2001, n = 150), F4 (2006–2008, n = 203), FF4 (2013/14, n = 212) cohort study. Information on patient self-management, physician-delivered care, medication, risk factor control and quality of life were assessed in standardized questionnaires and examinations. The 10-year coronary heart disease (CHD) risk was calculated using the UKPDS risk engine. Time trends were analyzed using multivariable linear and logistic regression models adjusted for age, sex, education, diabetes duration, and history of cardiovascular disease. Results From 2000 to 2014 the proportion of participants with type 2 diabetes receiving oral antidiabetic/cardio-protective medication and of those reaching treatment goals for glycemic control (HbA1c<7%, 60% to 71%, p = 0.09), blood pressure (<140/80 mmHg, 25% to 69%, p<0.001) and LDL cholesterol (<2.6 mmol/l, 13% to 27%, p<0.001) increased significantly. However, improvements were generally smaller from 2007 to 2014 than from 2000 to 2007. Modeled 10-year CHD risk decreased from 30% in 2000 to 24% in 2007 to 19% in 2014 (p<0.01). From 2007 to 2014, the prevalence of microvascular complications decreased and quality of life increased, but no improvements were observed for the majority of indicators of self-management. Conclusion Despite improvements, medication and risk factor control has remained suboptimal. The flattening of improvements and deteriorations in quality of (self-) care since 2007 indicate that more effort is needed to improve quality of care and patient self-management. Due to selection or lead time bias an overestimation of quality of care improvements cannot be ruled out.
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Affiliation(s)
- Michael Laxy
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- * E-mail:
| | - Gabriella Knoll
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- Institute for Medical Informatics, Biometrics and Epidemiology, Ludwig-Maximilians- Universität München, Munich, Germany
| | - Michaela Schunk
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
| | - Christa Meisinger
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München, Neuherberg, Germany
| | - Cornelia Huth
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
- Institute of Epidemiology II, Helmholtz Zentrum München, Neuherberg, Germany
| | - Rolf Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Neuherberg, Germany
- German Center for Diabetes Research (DZD), München-Neuherberg, Germany
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22
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Schrijnders D, Wever R, Kleefstra N, Houweling ST, van Hateren KJJ, de Bock GH, Bilo HJG, Groenier KH, Landman GWD. Addition of sulphonylurea to metformin does not relevantly change body weight: a prospective observational cohort study (ZODIAC-39). Diabetes Obes Metab 2016; 18:973-9. [PMID: 27265756 PMCID: PMC5129585 DOI: 10.1111/dom.12700] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/12/2016] [Accepted: 06/01/2016] [Indexed: 12/18/2022]
Abstract
AIM To investigate changes in body weight trajectories after the addition of individual sulphonylureas (SUs) to metformin in patients with type 2 diabetes. MATERIALS AND METHODS We conducted a retrospective observational cohort study, in a primary care setting in the Netherlands. Patients aged ≥18 years with type 2 diabetes who were included in the ZODIAC cohort between 1998 and 2012 and who received metformin monotherapy at inclusion (n = 29 195), and had used metformin as monotherapy for at least 1 year before receiving dual therapy through the addition of an SU for at least 1 year were eligible for inclusion. The primary outcome was within-drug yearly change in body weight after receiving add-on therapy with individual SUs during 5 years of follow-up. The secondary outcome was within-drug yearly change in glycated haemoglobin (HbA1c). Annual changes in weight and HbA1c were estimated with linear mixed models, adjusted for age, gender and diabetes duration. RESULTS A total of 2958 patients were included. No significant weight changes were observed within and between any of the individual SUs after treatment intensification (p = 0.24). In addition, no significant difference in weight between the add-on therapy combinations was observed (p = 0.26). The average HbA1c the year before intensification was 7.2% (55 mmol/mol) and dropped below 7.0% (53 mmol/mol) the year after. CONCLUSIONS In patients with type 2 diabetes treated in primary care, strict glycaemic control can be maintained with SUs used as add-on therapy to metformin, without the offset of relevant weight changes.
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Affiliation(s)
| | - Raiza Wever
- Diabetes Centre, Isala, Zwolle, The Netherlands
| | - Nanne Kleefstra
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Langerhans Medical Research Group, Zwolle, The Netherlands
- Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Sebastiaan T Houweling
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Langerhans Medical Research Group, Zwolle, The Netherlands
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Kornelis J J van Hateren
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Langerhans Medical Research Group, Zwolle, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Henk J G Bilo
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Department of Internal Medicine, Isala, Zwolle, The Netherlands
| | - Klaas H Groenier
- Department of General Practice, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Gijs W D Landman
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Langerhans Medical Research Group, Zwolle, The Netherlands
- Department of Internal Medicine, Gelre Hospital, Apeldoorn, The Netherlands
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23
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Munch L, Bennich B, Arreskov AB, Overgaard D, Konradsen H, Knop FK, Vilsbøll T, Røder ME. Shared care management of patients with type 2 diabetes across the primary and secondary healthcare sectors: study protocol for a randomised controlled trial. Trials 2016; 17:277. [PMID: 27259669 PMCID: PMC4893266 DOI: 10.1186/s13063-016-1409-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 05/26/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The prevalence of type 2 diabetes (T2D) is growing globally and hospital-based outpatient clinics are burdened with increasing numbers of patients. To ensure high quality treatment and care, it is necessary to structurally reorganise the management of patients with T2D. The objective of this study is to test if T2D patients (who are at intermediate risk of or are already having incipient diabetic complications) jointly managed by a hospital-based outpatient clinic and general practitioners (shared care programme) have a non-inferior outcome compared to an established programme in a specialised (hospital based) outpatient diabetes clinic. METHODS The study is designed as a randomised controlled trial. The shared care model will be tested during a period of 3 years, with data collection at baseline and at 12, 24 and 36 months. All patients will be offered four medical visits a year; the shared care intervention consists of one annual comprehensive check-up at the outpatient clinic and three quarterly visits at the general practitioners' office. The control group will be followed with four quarterly visits at the outpatient clinic, including an annual comprehensive check-up. In the outpatient clinic, the patients will be treated by a specialised diabetes team, including an endocrinologist. On the basis of a predefined stratification model, we will recruit patients stratified to be at intermediate risk of or already having incipient diabetic complications. We plan to include 140 patients. The primary outcome is glycated haemoglobin. Other outcome measures include (1) the proportion of patients who meet the Danish standard indicators reflecting quality of care; (2) quality of life measured by Short Form 36; and (3) the functionality of the patients' families measured by Family Assessment Measure III. The experiences of the patients and families when participating in the shared care program will be explored by collecting dyadic interviews. DISCUSSION This study will evaluate the quality of a shared care programme for patients with T2D, and provide evidence about advantages and disadvantages compared with a programme in a specialised outpatient clinic. The results may provide important information on how to organise the care for patients with T2D in the future. TRIAL REGISTRATION This trial was registered with Clinicaltrials.gov on 21 October 2015, registration number: NCT02586545 .
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Affiliation(s)
- Lene Munch
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900, Hellerup, Denmark
- Institute of Nursing, Metropolitan University College, Copenhagen, Denmark
| | - Birgitte Bennich
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900, Hellerup, Denmark
- Institute of Nursing, Metropolitan University College, Copenhagen, Denmark
| | - Anne B Arreskov
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900, Hellerup, Denmark
| | - Dorthe Overgaard
- Institute of Nursing, Metropolitan University College, Copenhagen, Denmark
| | - Hanne Konradsen
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Hundinge, Sweden
| | - Filip K Knop
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900, Hellerup, Denmark
- NNF Center for Basic Metabolic Research and Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tina Vilsbøll
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900, Hellerup, Denmark
| | - Michael E Røder
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, DK-2900, Hellerup, Denmark.
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Van Gelder VA, Scherpbier-De Haan ND, De Grauw WJ, Vervoort GM, Van Weel C, Biermans MC, Braspenning JC, Wetzels JF. Quality of chronic kidney disease management in primary care: a retrospective study. Scand J Prim Health Care 2016; 34:73-80. [PMID: 26853071 PMCID: PMC4911031 DOI: 10.3109/02813432.2015.1132885] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Early detection and appropriate management of chronic kidney disease (CKD) in primary care are essential to reduce morbidity and mortality. AIM To assess the quality of care (QoC) of CKD in primary healthcare in relation to patient and practice characteristics in order to tailor improvement strategies. DESIGN AND SETTING Retrospective study using data between 2008 and 2011 from 47 general practices (207 469 patients of whom 162 562 were adults). METHOD CKD management of patients under the care of their general practitioner (GP) was qualified using indicators derived from the Dutch interdisciplinary CKD guideline for primary care and nephrology and included (1) monitoring of renal function, albuminuria, blood pressure, and glucose, (2) monitoring of metabolic parameters, and alongside the guideline: (3) recognition of CKD. The outcome indicator was (4) achieving blood pressure targets. Multilevel logistic regression analysis was applied to identify associated patient and practice characteristics. RESULTS Kidney function or albuminuria data were available for 59 728 adult patients; 9288 patients had CKD, of whom 8794 were under GP care. Monitoring of disease progression was complete in 42% of CKD patients, monitoring of metabolic parameters in 2%, and blood pressure target was reached in 43.1%. GPs documented CKD in 31.4% of CKD patients. High QoC was strongly associated with diabetes, and to a lesser extent with hypertension and male sex. CONCLUSION Room for improvement was found in all aspects of CKD management. As QoC was higher in patients who received structured diabetes care, future CKD care may profit from more structured primary care management, e.g. according to the chronic care model. KEY POINTS Quality of care for chronic kidney disease patients in primary care can be improved. In comparison with guideline advice, adequate monitoring of disease progression was observed in 42%, of metabolic parameters in 2%, correct recognition of impaired renal function in 31%, and reaching blood pressure targets in 43% of chronic kidney disease patients. Quality of care was higher in patients with diabetes. Chronic kidney disease management may be improved by developing strategies similar to diabetes care.
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Affiliation(s)
- Vincent A. Van Gelder
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
- CONTACT Vincent van Gelder, MD MSc Department of Primary and Community Care, Postal Route 117, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands
| | | | - Wim J.C. De Grauw
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gerald M.M. Vervoort
- Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Marion C.J. Biermans
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jozé C.C. Braspenning
- IQ Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jack F.M. Wetzels
- Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands
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25
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Hendriks SH, van Hateren KJJ, Groenier KH, Houweling ST, Maas AHEM, Kleefstra N, Bilo HJG. Sex Differences in the Quality of Diabetes Care in the Netherlands (ZODIAC-45). PLoS One 2015; 10:e0145907. [PMID: 26713444 PMCID: PMC4703132 DOI: 10.1371/journal.pone.0145907] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/10/2015] [Indexed: 11/30/2022] Open
Abstract
Objective Our aim was to investigate whether trends in quality of diabetes care differ between sexes in the Netherlands from 1998 till 2013. Research Design and Methods In this prospective observational cohort study quality of care was measured using process and outcome measures in patients with type 2 diabetes in primary care. Trend and absolute differences between sexes were investigated for patients <75 years. Subgroup analyses were performed in patients ≥75 years. 10-year mortality risk was assessed with the Globorisk risk equation in patients without cardiovascular diseases <75 years. Results The number of patients increased from 2,644 in 1998 to 62,230 in 2013. In 1998, 51% of the men and 60% of the women <75 years had an HbA1c >53 mmol/mol; this decreased to approximately 29% in both sexes in 2013. Patients having a systolic blood pressure >140 mmHg decreased from 70% to 42%, and from 80% to 40% in men and women <75 years, respectively. In patients ≥75 years it decreased from 72% to 50% in men and 85% to 56% in women. Obesity increased in both sexes, whereas smoking in men and women declined in patients <75 years (men: 34% to 22%; women: 22% to 18%). The number of patients with a mortality risk >20% over 10 years decreased from 15% to 3% in men and from 18% to 3% in women. Conclusions Quality of diabetes care has improved considerably in the period 1998–2013 in both sexes. Possibly relevant trend differences between sexes were observed for HbA1c, systolic blood pressure, BMI and smoking. The predicted mortality risk decreased over time in both sexes. Except for BMI in both age groups and systolic blood pressure in patients ≥75 years, no evident poorer risk factor control in women compared to men was found at the end of the study period.
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Affiliation(s)
| | | | - Klaas H. Groenier
- Department of General Practice, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - Sebastiaan T. Houweling
- Diabetes Centre, Isala, Zwolle, the Netherlands
- Langerhans Medical Research Group, Zwolle, the Netherlands
| | - Angela H. E. M. Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nanne Kleefstra
- Diabetes Centre, Isala, Zwolle, the Netherlands
- Langerhans Medical Research Group, Zwolle, the Netherlands
- Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
| | - Henk J. G. Bilo
- Diabetes Centre, Isala, Zwolle, the Netherlands
- Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands
- Department of Internal Medicine, Isala, Zwolle, the Netherlands
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26
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Torre C, Guerreiro J, de Oliveira Martins S, Raposo JF, Martins AP, Leufkens H. Patterns of glucose lowering drugs utilization in Portugal and in the Netherlands. Trends over time. Prim Care Diabetes 2015; 9:482-489. [PMID: 25911273 DOI: 10.1016/j.pcd.2015.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 02/05/2015] [Accepted: 03/19/2015] [Indexed: 10/23/2022]
Abstract
AIMS To compare the temporal trends in the consumption patterns of glucose lowering drugs (GLD) between Portugal and the Netherlands from 2004 to 2013 and to examine possible reasons behind the cross-national variation found. METHODS All GLD (ATC pharmacological subgroup A10B) were selected for analysis. Consumption data were obtained for the 10-year period. Portuguese and Dutch drug estimates were obtained from nationwide databases. RESULTS The consumption of GLD increased in Portugal from 52.9 defined daily dose per 1000 inhabitants per day (DHD) in 2004 to 70.0 DHD in 2013 and in the Netherlands from 44.9 DHD in 2004 to 50.7 DHD in 2013. In Portugal, the use of fixed-dose combinations, especially with dipeptidyl peptidase-4 inhibitors (DPP-4) increased remarkably and in 2013 represented almost a quarter of total GLD consumption. In the Netherlands, the use of combinations was residual. CONCLUSIONS The consumption of GLD rose over the 10-year period in both countries. However, Portuguese overall consumption and costs of GLD were higher. The differentially rapid uptake of DPP-4 inhibitors in Portugal was the main driver of the cost difference.
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Affiliation(s)
- Carla Torre
- Centre for Health Evaluation & Research (CEFAR), National Association of Pharmacies, Lisboa, Portugal; Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Portugal.
| | - José Guerreiro
- Centre for Health Evaluation & Research (CEFAR), National Association of Pharmacies, Lisboa, Portugal
| | - Sofia de Oliveira Martins
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Portugal; Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal
| | - João Filipe Raposo
- Faculty of Medical Sciences, New University of Lisbon, Lisboa, Portugal; Portuguese Diabetes Association (APDP), Lisboa, Portugal
| | - Ana Paula Martins
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Portugal; Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal
| | - Hubert Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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de Vries ST, de Vries FM, Dekker T, Haaijer-Ruskamp FM, de Zeeuw D, Ranchor AV, Denig P. The Role of Patients' Age on Their Preferences for Choosing Additional Blood Pressure-Lowering Drugs: A Discrete Choice Experiment in Patients with Diabetes. PLoS One 2015; 10:e0139755. [PMID: 26445349 PMCID: PMC4596700 DOI: 10.1371/journal.pone.0139755] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 09/15/2015] [Indexed: 01/18/2023] Open
Abstract
Objectives To assess whether patients’ willingness to add a blood pressure-lowering drug and the importance they attach to specific treatment characteristics differ among age groups in patients with type 2 diabetes. Materials and Methods Patients being prescribed at least an oral glucose-lowering and a blood pressure-lowering drug completed a questionnaire including a discrete choice experiment. This experiment contained choice sets with hypothetical blood pressure-lowering drugs and a no additional drug alternative, which differed in their characteristics (i.e. effects and intake moments). Differences in willingness to add a drug were compared between patients <75 years (non-aged) and ≥75 years (aged) using Pearson χ2-tests. Multinomial logit models were used to assess and compare the importance attached to the characteristics. Results Of the 161 patients who completed the questionnaire, 151 (72%) could be included in the analyses (mean age 68 years; 42% female). Aged patients were less willing to add a drug than non-aged patients (67% versus 84% respectively; P = 0.017). In both age groups, the effect on blood pressure was most important for choosing a drug, followed by the risk of adverse drug events and the risk of death. The effect on limitations due to stroke was only significant in the non-aged group. The effect on blood pressure was slightly more important in the non-aged than the aged group (P = 0.043). Conclusions Aged patients appear less willing to add a preventive drug than non-aged patients. The importance attached to various treatment characteristics does not seem to differ much among age groups.
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Affiliation(s)
- Sieta T. de Vries
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Folgerdiena M. de Vries
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Thijs Dekker
- Institute for Transport Studies, University of Leeds, Leeds, United Kingdom
| | - Flora M. Haaijer-Ruskamp
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dick de Zeeuw
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adelita V. Ranchor
- Department of Health Psychology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
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Effect of shared care on blood pressure in patients with chronic kidney disease: a cluster randomised controlled trial. Br J Gen Pract 2015; 63:e798-806. [PMID: 24351495 DOI: 10.3399/bjgp13x675386] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is highly prevalent in patients with diabetes or hypertension in primary care. A shared care model could improve quality of care in these patients AIM To assess the effect of a shared care model in managing patients with CKD who also have diabetes or hypertension. Design and setting A cluster randomised controlled trial in nine general practices in The Netherlands. METHOD Five practices were allocated to the shared care model and four practices to usual care for 1 year. Primary outcome was the achievement of blood pressure targets (130/80 mmHg) and lowering of blood pressure in patients with diabetes mellitus or hypertension and an estimated glomerular filtration rate (eGFR)<60 ml/min/1.73 m(2). RESULTS Data of 90 intervention and 74 control patients could be analysed. Blood pressure in the intervention group decreased with 8.1 (95% CI = 4.8 to 11.3)/1.1 (95% CI = -1.0 to 3.2) compared to -0.2 (95% CI = -3.8 to 3.3)/-0.5 (95% CI = -2.9 to 1.8) in the control group. Use of lipid-lowering drugs, angiotensin-system inhibitors and vitamin D was higher in the intervention group than in the control group (73% versus 51%, 81% versus 64%, and 15% versus 1%, respectively, [P = 0.004, P = 0.01, and P = 0.002]). CONCLUSION A shared care model between GP, nurse practitioner and nephrologist is beneficial in reducing systolic blood pressure in patients with CKD in primary care.
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den Ouden H, Vos RC, Reidsma C, Rutten GEHM. Shared decision making in type 2 diabetes with a support decision tool that takes into account clinical factors, the intensity of treatment and patient preferences: design of a cluster randomised (OPTIMAL) trial. BMC FAMILY PRACTICE 2015; 16:27. [PMID: 25887759 PMCID: PMC4369865 DOI: 10.1186/s12875-015-0230-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 01/23/2015] [Indexed: 11/13/2022]
Abstract
BACKGROUND No more than 10-15% of type 2 diabetes mellitus (T2DM) patients achieve all treatment goals regarding glycaemic control, lipids and blood pressure. Shared decision making (SDM) should increase that percentage; however, not all support decision tools are appropriate. Because the ADDITION-Europe study demonstrated two (almost) equally effective treatments but with slightly different intensities, it may be a good starting point to discuss with the patients their diabetes treatment, taking into account both the intensity of treatment, clinical factors and patients' preferences. We aim to evaluate whether such an approach increases the proportion of patients that achieve all three treatment goals. METHODS In a cluster-randomised trial including 40 general practices, that participated until 2009 in the ADDITION Study, 150 T2DM patients 60-80 years, known with T2DM for 8-15 years, will be included. Practices are randomised a second time, i.e. intervention practices in the ADDITION study could be control practices in the current study and vice versa. For the GPs from the intervention group a 2-hour training in SDM was developed as well as a decision support tool to be used during the consultation. GPs plan the first visit with the patients to decide on the intensity of the treatment, personalised targets and the priorities of treatment. The control group will continue with the treatment they were allocated to in the ADDITION study. FOLLOW-UP 24 months. The primary outcome is the proportion of patients who achieve all three treatment goals. Secondary outcomes are the proportion of patients who achieve five treatment goals (HbA1c, blood pressure, total cholesterol, body weight, not smoking), evaluation of the SDM process (SDM-Q9 and CPS), satisfaction with the treatment (DTSQ), wellbeing and quality of life (W-BQ12, ADD QoL-19), health status (SF-36, EQ-5D) and coping (DCMQ). The proportions of achieved treatment goals will be compared between both groups. For the secondary outcomes mixed models will be used. The Medical Research Ethics Committee of the University Medical Centre Utrecht has approved the study protocol (Protocol number: 11-153). DISCUSSION This trial will provide evidence whether an intervention with a multi-faceted decision support tool increases the proportion of achieved personalised goals in type 2 diabetes patients. TRIAL REGISTRATION NCT02285881, November 4, 2014.
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Affiliation(s)
- Henk den Ouden
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Str. 6.131, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Rimke C Vos
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Str. 6.131, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Carla Reidsma
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Str. 6.131, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Guy E H M Rutten
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Str. 6.131, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
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van Dijk PR, Kramer A, Logtenberg SJJ, Hoitsma AJ, Kleefstra N, Jager KJ, Bilo HJG. Incidence of renal replacement therapy for diabetic nephropathy in the Netherlands: Dutch diabetes estimates (DUDE)-3. BMJ Open 2015; 5:e005624. [PMID: 25636789 PMCID: PMC4316478 DOI: 10.1136/bmjopen-2014-005624] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Describe the incidence, prevalence and survival of patients needing renal replacement therapy (RRT) for end-stage renal disease (ESRD) due to diabetes mellitus (DM)-related glomerulosclerosis or nephropathy (diabetic nephropathy, DN) in the Netherlands. DESIGN Using the national registry for RRT (RENINE-registry), data of all Dutch individuals initiating RRT for ESRD and having DN as primary diagnosis in the period 2000-2012 were obtained. SETTING Observational study in the Netherlands. PATIENTS Patients with ESRD needing RRT for DN. OUTCOME MEASUREMENTS Age and gender adjusted incidence and prevalence of RRT for DN in the period 2000-2012. In addition, trends in time and patient's survival were examined. RESULTS The prevalence of DM in the general population increased from approximately 466 000 in 2000 to 815 000 in 2011. The number of individuals who started RRT with DN as primary diagnosis was 17.4 per million population (pmp) in 2000 and 19.1 pmp in 2012, with an annual percentage change (APC) of 0.8% (95% CI -0.4 to 2.0). For RRT due to type 1 DN, the incidence decreased from 7.3 to 3.5 pmp (APC -4.8%, 95% CI -6.5 to -3.1) while it increased for type 2 DN from 10.1 to 15.6 pmp (APC 3.1%, 95% CI 1.3 to 4.8). After 2009, the prevalence of RRT for DN remained stable (APC 1.0%, 95% CI -0.4 to 2.5). Compared to the period 2000-2004, patients initiating RRT and dialysis in 2005-2009 had better survival, HRs 0.8 (95% CI 0.7 to 0.8) and 0.8 (95% CI 0.7 to 0.9), respectively, while survival after kidney transplantation remained stable, HR 0.8, 95% CI 0.5 to 1.1). CONCLUSIONS Over the last decade, the incidence of RRT for DN was stable, with a decrease in RRT due to type 1 DN and an increase due to type 2 DN, while survival increased.
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Affiliation(s)
| | - Anneke Kramer
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, ERA-EDTA Registry, Amsterdam, The Netherlands
| | - Susan J J Logtenberg
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Andries J Hoitsma
- Department of Nephrology, Radboud University Medical Centre, Nijmegen, The Netherlands
- RENINE Registry, Leiden, The Netherlands
| | - Nanne Kleefstra
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Kitty J Jager
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, ERA-EDTA Registry, Amsterdam, The Netherlands
| | - Henk J G Bilo
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Internal Medicine, Isala, Zwolle, The Netherlands
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Oude Wesselink SF, Lingsma HF, Robben PBM, Mackenbach JP. Guideline adherence and health outcomes in diabetes mellitus type 2 patients: a cross-sectional study. BMC Health Serv Res 2015; 15:22. [PMID: 25608447 PMCID: PMC4312465 DOI: 10.1186/s12913-014-0669-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 12/16/2014] [Indexed: 12/03/2022] Open
Abstract
Background The complex disease of diabetes mellitus type 2 (T2DM) requires a high standard of quality of care. Clinical practice guidelines define norms for diabetes care that ensure regular monitoring of T2DM patients, including annual diagnostic tests. This study aims to quantify guideline adherence in Dutch general practices providing care to T2DM patients and explores the association between guideline adherence and patients’ health outcomes. Methods In this cross-sectional study, we studied 363 T2DM patients in 32 general practices in 2011 and 2012. Guideline adherence was measured by comparing structure and process indicators of care with recommendations in the national diabetes care guideline. Health outcomes included biomedical measures and health behaviours. Data was extracted from medical records. The association between guideline adherence and health outcomes was analysed using hierarchical linear and logistic regression models. Results Guideline adherence varied between different recommendations. For example 53% of the practices had a system for collecting patient experience feedback, while 97% had a policy for no-show patients. With regard to process indicators of care, guideline adherence was below 50% for foot, eye and urine albumin examination and high (>85%) for blood pressure, HbA1c and smoking behaviour assessment. Although guideline adherence varied considerably between practices, after adjusting for patient characteristics we found guideline adherence not to be associated with patients’ health outcomes. Conclusions Guideline adherence in Dutch general practices offering diabetes care was not optimal. Despite considerable variations between general practices, we found no clear relationship between guideline adherence and health outcomes. More research is needed to better understand the relationship between guideline adherence and health outcomes, specifically for guidelines that are based on limited scientific evidence. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0669-z) contains supplementary material, which is available to authorized users.
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Roelofsen Y, Hendriks SH, Sieverink F, van Vugt M, van Hateren KJJ, Snoek FJ, de Wit M, Gans ROB, Groenier KH, van Gemert-Pijnen JEWC, Kleefstra N, Bilo HJG. Design of the e-Vita diabetes mellitus study: effects and use of an interactive online care platform in patients with type 2 diabetes (e-VitaDM-1/ZODIAC-40). BMC Endocr Disord 2014; 14:22. [PMID: 24593656 PMCID: PMC4016215 DOI: 10.1186/1472-6823-14-22] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 02/25/2014] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED Trial registration: NCT01570140. BACKGROUND Due to ongoing rise in need for care for people with chronic diseases and lagging increase in number of care providers, alternative forms of care provision and self-management support are needed. Empowering patients through an online care platform could help to improve patients' self-management and reduce the burden on the healthcare system. METHODS Access to laboratory results and educational modules on diabetes will be offered through a platform for subjects with type 2 diabetes mellitus treated in primary care. Differences in socio-demographic and clinical characteristics between subjects expressing interest vs. disinterest to use the platform will be explored. Platform usage will be tracked and compared. Patient satisfaction and quality of life will be measured by validated questionnaires and economic analyses will be performed. DISCUSSION This study is designed to assess the feasibility of use of an online platform in routine primary healthcare for subjects with type 2 diabetes mellitus in the Netherlands, and to study effects of use of the platform on treatment satisfaction, quality of life and clinical parameters. Although providing access to a online platform is not a novel intervention, usage and effects have not yet been studied in this patient population.
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Affiliation(s)
| | | | - Floor Sieverink
- Center for eHealth Research and Disease Management, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Michael van Vugt
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Frank J Snoek
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - Maartje de Wit
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - Rijk OB Gans
- Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Klaas H Groenier
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Department of General Practice, University Medical Center Groningen, Groningen, The Netherlands
| | - Julia EWC van Gemert-Pijnen
- Center for eHealth Research and Disease Management, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Nanne Kleefstra
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
- Langerhans Medical Research Group, Zwolle, The, Netherlands
| | - Henk JG Bilo
- Diabetes Centre, Isala, Zwolle, The Netherlands
- Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
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Roelofsen Y, Hendriks SH, Sieverink F, Landman GWD, Groenier KH, Bilo HJG, Kleefstra N. Differences Between Patients With Type 2 Diabetes Mellitus Interested and Uninterested in the Use of a Patient Platform (e-VitaDM-2/ZODIAC-41). J Diabetes Sci Technol 2014; 8:230-237. [PMID: 24876572 PMCID: PMC4455415 DOI: 10.1177/1932296814524496] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The prevalence of type 2 diabetes mellitus (T2DM) is rising in the Netherlands, and health care's workload will increase. e-Health applications may increase patients' participation in their care and could help reducing workload. To explore potential users, differences in patients interested and uninterested in e-Health are characterized. A prospective cohort study was initiated in the Drenthe region of the Netherlands. This study included inviting T2DM patients to use e-Health (the e-Vita platform). Patients were offered access to clinical data, laboratory results, educational modules, and a self-management support program. Data were obtained from health record systems of general practices and questionnaires. Out of 2674 patients, 1378 (51.5%) participated in the study. Of the 1378 patients, 974 (70.7%) were interested in e-Health. Of 974, 405 (41.6%) were registered for e-Health. Interested patients were more often male, were younger, had shorter T2DM duration, and were higher educated. Of 405, 110 (27.2%) used the e-Health. No differences were found between users and nonusers of e-Health. Patients interested in e-Health were more often male, were younger, had shorter T2DM duration, and were more often higher educated. However, even in this interested group, the actual participation rate remained low. Together with characteristics and attitudes of caregivers and T2DM patients, the look and content of the e-Health platform strategies that increase interest and participation need to be developed.
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Affiliation(s)
| | | | - Floor Sieverink
- Center for eHealth Research and Disease Management, Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands
| | | | - Klaas H Groenier
- Diabetes Centre, Isala, Zwolle, the Netherlands University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands
| | - Henk J G Bilo
- Diabetes Centre, Isala, Zwolle, the Netherlands University of Groningen and University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands
| | - Nanne Kleefstra
- Diabetes Centre, Isala, Zwolle, the Netherlands University of Groningen and University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands Langerhans Medical Research Group, Zwolle, the Netherlands
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Hellemons ME, Denig P, de Zeeuw D, Voorham J, Lambers Heerspink HJ. Is albuminuria screening and treatment optimal in patients with type 2 diabetes in primary care? Observational data of the GIANTT cohort. Nephrol Dial Transplant 2012; 28:706-15. [PMID: 23262433 DOI: 10.1093/ndt/gfs567] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Failure of diagnosing and treatment of albuminuria play a role in morbidity and mortality in type 2 diabetes (T2DM). We evaluated guideline adherence and factors associated with albuminuria screening and treatment in T2DM patients in primary care. METHODS Guidelines recommend annual measurement of albuminuria and, if increased, treatment with renin-angiotensin-aldosterone system (RAAS) blockers. We performed a cohort study of T2DM patients managed by 182 Dutch general practitioners (GPs; Groningen Initiative to Analyse Type 2 diabetes Treatment database), and evaluated guideline adherence in the years 2007-2009. We assessed whether demographic, clinical, organizational or provider factors determined guideline adherence with multilevel analyses. RESULTS Data were available for 14 120 T2DM patients [47.6% male, mean age 67.3 ± 11.7 years, median diabetes duration 6 (IQR: 3-10) years]. The albumin-creatinine ratio (ACR) was measured in 45.2% in 2007, 57.4% in 2008 and 56.8% in 2009. Only 23.7% of all patients were measured every year and 21.4% were never measured. The ACR was more often measured in patients <75 years, with a previous ACR measurement, using anti-diabetic medication, and receiving additional care by a diabetes support facility. RAAS treatment was prescribed to 78.4% of patients with prevalent micro/macroalbuminuria, 66.5% with incident micro/macroalbuminuria, 59.3% with normoalbuminuria and 52.1% of those without ACR measurements. In those not treated with RAAS blockers, it was initiated in 14.3, 12.3, 3.0 and 2.3%, respectively. The presence of micro/macroalbuminuria, higher blood pressure, incidence of cardiovascular events and treatment with antihypertensive medication were the determinants of RAAS-treatment initiation. CONCLUSIONS Guideline implementation regarding the management of albuminuria in T2DM patients in primary care should be further improved.
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Affiliation(s)
- Merel E Hellemons
- Department of Clinical Pharmacology, University Medical Center Groningen, Groningen, the Netherlands
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