Care trajectories are associated with quality improvement in the treatment of patients with uncontrolled type 2 diabetes: a registry based cohort study

G. Goderis; V. van Casteren; E. Declercq; N. Bossuyt; C. van den Broeke; K. Vanthomme; S. Moreels; F. Nobels; C. Mathieu; F. Buntinx

doi:10.1016/j.pcd.2015.01.008

Care trajectories are associated with quality improvement in the treatment of patients with uncontrolled type 2 diabetes: a registry based cohort study

G. Goderis^*, V. van Casteren, E. Declercq, N. Bossuyt, C. van den Broeke, K. Vanthomme, S. Moreels, F. Nobels, C. Mathieu, F. Buntinx

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Aims: To analyse whether care trajectories (CT) were associated with increased prevalence of parenteral hypoglycemic treatment (PHT = insulin or GLP-1 analogues), statin therapy or RAAS-inhibition. Introduced in 2009 in Belgium, CTs target patients with type 2 diabetes mellitus (T2DM), in need for or with PHT.

Methods: Retrospective study based on a registry with 97 general practitioners. The evolution in treatment since 2006 was compared between patients with vs. without a CT, using longitudinal logistic regression.

Results: Comparing patients with (N = 271) vs. without a CT (N=4424), we noted significant differences (p <0.05) in diabetes duration (10.1 vs. 7.3 years), HbA1c (7.5 vs. 6.9%), LDL-C (85 vs. 98 mg/di), microvascular complications (26 vs. 16%). Moreover, in 2006, parenteral treatment (OR 52.1), statins (OR 4.1) and RAAS-inhibition (OR 9.6) were significantly more prevalent (p <0.001). Between 2006 and 2011, the prevalence rose in both groups regarding all three treatments, but rose significantly faster (p <0.05) after 2009 in the CT-group.

Conclusions: Patients enrolled in a CT differ from other patients even before the start of this initiative with more intense hypoglycemic and cardiovascular treatment. Yet, they presented higher HbA1c-levels and more complications. Enrolment in a CT is associated with additional treatment intensification. (C) 2015 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Original language	English
Pages (from-to)	354-361
Number of pages	8
Journal	Primary Care Diabetes
Volume	9
Issue number	5
DOIs	https://doi.org/10.1016/j.pcd.2015.01.008
Publication status	Published - Oct 2015

Keywords

Type 2 diabetes mellitus
Quality of care
Chronic disease management
Effectiveness
Retrospective cohort study
CLINICAL INERTIA
DISEASE MANAGEMENT
INSULIN
INITIATION
NETWORKS
BARRIERS
GLUCOSE
PROJECT

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10.1016/j.pcd.2015.01.008

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Goderis, G., van Casteren, V., Declercq, E., Bossuyt, N., van den Broeke, C., Vanthomme, K., Moreels, S., Nobels, F., Mathieu, C., & Buntinx, F. (2015). Care trajectories are associated with quality improvement in the treatment of patients with uncontrolled type 2 diabetes: a registry based cohort study. Primary Care Diabetes, 9(5), 354-361. https://doi.org/10.1016/j.pcd.2015.01.008

@article{53defc6c9447458a80de3f7d754c4c27,

title = "Care trajectories are associated with quality improvement in the treatment of patients with uncontrolled type 2 diabetes: a registry based cohort study",

abstract = "Aims: To analyse whether care trajectories (CT) were associated with increased prevalence of parenteral hypoglycemic treatment (PHT = insulin or GLP-1 analogues), statin therapy or RAAS-inhibition. Introduced in 2009 in Belgium, CTs target patients with type 2 diabetes mellitus (T2DM), in need for or with PHT.Methods: Retrospective study based on a registry with 97 general practitioners. The evolution in treatment since 2006 was compared between patients with vs. without a CT, using longitudinal logistic regression.Results: Comparing patients with (N = 271) vs. without a CT (N=4424), we noted significant differences (p <0.05) in diabetes duration (10.1 vs. 7.3 years), HbA1c (7.5 vs. 6.9%), LDL-C (85 vs. 98 mg/di), microvascular complications (26 vs. 16%). Moreover, in 2006, parenteral treatment (OR 52.1), statins (OR 4.1) and RAAS-inhibition (OR 9.6) were significantly more prevalent (p <0.001). Between 2006 and 2011, the prevalence rose in both groups regarding all three treatments, but rose significantly faster (p <0.05) after 2009 in the CT-group.Conclusions: Patients enrolled in a CT differ from other patients even before the start of this initiative with more intense hypoglycemic and cardiovascular treatment. Yet, they presented higher HbA1c-levels and more complications. Enrolment in a CT is associated with additional treatment intensification. (C) 2015 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.",

keywords = "Type 2 diabetes mellitus, Quality of care, Chronic disease management, Effectiveness, Retrospective cohort study, CLINICAL INERTIA, DISEASE MANAGEMENT, INSULIN, INITIATION, NETWORKS, BARRIERS, GLUCOSE, PROJECT",

author = "G. Goderis and {van Casteren}, V. and E. Declercq and N. Bossuyt and {van den Broeke}, C. and K. Vanthomme and S. Moreels and F. Nobels and C. Mathieu and F. Buntinx",

year = "2015",

month = oct,

doi = "10.1016/j.pcd.2015.01.008",

language = "English",

volume = "9",

pages = "354--361",

journal = "Primary Care Diabetes",

issn = "1751-9918",

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Goderis, G, van Casteren, V, Declercq, E, Bossuyt, N, van den Broeke, C, Vanthomme, K, Moreels, S, Nobels, F, Mathieu, C & Buntinx, F 2015, 'Care trajectories are associated with quality improvement in the treatment of patients with uncontrolled type 2 diabetes: a registry based cohort study', Primary Care Diabetes, vol. 9, no. 5, pp. 354-361. https://doi.org/10.1016/j.pcd.2015.01.008

TY - JOUR

T1 - Care trajectories are associated with quality improvement in the treatment of patients with uncontrolled type 2 diabetes: a registry based cohort study

AU - Goderis, G.

AU - van Casteren, V.

AU - Declercq, E.

AU - Bossuyt, N.

AU - van den Broeke, C.

AU - Vanthomme, K.

AU - Moreels, S.

AU - Nobels, F.

AU - Mathieu, C.

AU - Buntinx, F.

PY - 2015/10

Y1 - 2015/10

N2 - Aims: To analyse whether care trajectories (CT) were associated with increased prevalence of parenteral hypoglycemic treatment (PHT = insulin or GLP-1 analogues), statin therapy or RAAS-inhibition. Introduced in 2009 in Belgium, CTs target patients with type 2 diabetes mellitus (T2DM), in need for or with PHT.Methods: Retrospective study based on a registry with 97 general practitioners. The evolution in treatment since 2006 was compared between patients with vs. without a CT, using longitudinal logistic regression.Results: Comparing patients with (N = 271) vs. without a CT (N=4424), we noted significant differences (p <0.05) in diabetes duration (10.1 vs. 7.3 years), HbA1c (7.5 vs. 6.9%), LDL-C (85 vs. 98 mg/di), microvascular complications (26 vs. 16%). Moreover, in 2006, parenteral treatment (OR 52.1), statins (OR 4.1) and RAAS-inhibition (OR 9.6) were significantly more prevalent (p <0.001). Between 2006 and 2011, the prevalence rose in both groups regarding all three treatments, but rose significantly faster (p <0.05) after 2009 in the CT-group.Conclusions: Patients enrolled in a CT differ from other patients even before the start of this initiative with more intense hypoglycemic and cardiovascular treatment. Yet, they presented higher HbA1c-levels and more complications. Enrolment in a CT is associated with additional treatment intensification. (C) 2015 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

AB - Aims: To analyse whether care trajectories (CT) were associated with increased prevalence of parenteral hypoglycemic treatment (PHT = insulin or GLP-1 analogues), statin therapy or RAAS-inhibition. Introduced in 2009 in Belgium, CTs target patients with type 2 diabetes mellitus (T2DM), in need for or with PHT.Methods: Retrospective study based on a registry with 97 general practitioners. The evolution in treatment since 2006 was compared between patients with vs. without a CT, using longitudinal logistic regression.Results: Comparing patients with (N = 271) vs. without a CT (N=4424), we noted significant differences (p <0.05) in diabetes duration (10.1 vs. 7.3 years), HbA1c (7.5 vs. 6.9%), LDL-C (85 vs. 98 mg/di), microvascular complications (26 vs. 16%). Moreover, in 2006, parenteral treatment (OR 52.1), statins (OR 4.1) and RAAS-inhibition (OR 9.6) were significantly more prevalent (p <0.001). Between 2006 and 2011, the prevalence rose in both groups regarding all three treatments, but rose significantly faster (p <0.05) after 2009 in the CT-group.Conclusions: Patients enrolled in a CT differ from other patients even before the start of this initiative with more intense hypoglycemic and cardiovascular treatment. Yet, they presented higher HbA1c-levels and more complications. Enrolment in a CT is associated with additional treatment intensification. (C) 2015 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

KW - Type 2 diabetes mellitus

KW - Quality of care

KW - Chronic disease management

KW - Effectiveness

KW - Retrospective cohort study

KW - CLINICAL INERTIA

KW - DISEASE MANAGEMENT

KW - INSULIN

KW - INITIATION

KW - NETWORKS

KW - BARRIERS

KW - GLUCOSE

KW - PROJECT

U2 - 10.1016/j.pcd.2015.01.008

DO - 10.1016/j.pcd.2015.01.008

M3 - Article

C2 - 25709079

SN - 1751-9918

VL - 9

SP - 354

EP - 361

JO - Primary Care Diabetes

JF - Primary Care Diabetes

IS - 5

ER -

Care trajectories are associated with quality improvement in the treatment of patients with uncontrolled type 2 diabetes: a registry based cohort study

Abstract

Keywords

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