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 journalArticleAcademicpeer-review


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 languageEnglish
Pages (from-to)354-361
Number of pages8
JournalPrimary Care Diabetes
Issue number5
Publication statusPublished - Oct 2015


  • Type 2 diabetes mellitus
  • Quality of care
  • Chronic disease management
  • Effectiveness
  • Retrospective cohort study

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