Mode of treatments and achievement of treatment targets among type 2 diabetes patients with different comorbidities - a register-based retrospective cohort study in Finland

Aims Type 2 diabetes (T2D) is a progressive disease often associated with comorbidities that complicate the management of T2D and affect the achievement of treatment targets. However, adherence to guidelines and individualized treatments can potentially improve treatment outcomes. This study assessed the association between different glucose lowering and lipid lowering medication lines and the achievement of treatment targets with different comorbidities among a T2D cohort in North Karelia, Finland (2011-12 to 2015-16). Methods The data on all diagnosed T2D patients (n = 10,190) in North Karelia were collated retrospectively from regional electronic health records (EHRs). Analyses were performed considering the age, sex, and comorbidities such as cardiovascular diseases (CVD) and any mental disorders (AMD). We analyzed the trends in using glucose lowering and lipid lowering medications and the effect of changes in medication on the achievement of treatment targets among different patient groups. Results Metformin was the most common treatment in all patient groups. The use of only metformin declined and the use of metformin and/or other non-insulin medications increased during the follow-up. A Combination of insulin and non-insulin medication was mostly used by T2D patients with both cardiovascular diseases and mental disorders (T2D + CVD + AMD), and the use of insulin increased among this group in follow-up. Achievement of the glucose treatment target deteriorated even after the intensification of medication among all patient groups during the follow-up. A considerably higher number of patients with T2D + AMD and T2D + CVD + AMD did not use lipid lowering medication when compared to the T2D + CVD patients both at baseline and follow-up. However, the achievement of the LDL treatment target improved during the follow-up. Conclusion Achievement of the glucose target deteriorated even after the intensification of treatment, and especially among patients with multiple diseases. Many T2D patients with AMD and CVD remained without lipid lowering medication, which needs further attention.Peer reviewe

Association of mental disorders and quality of diabetes care-A six-year follow-up study of type 2 diabetes patients in North Karelia, Finland

Aims: To compare the quality of diabetes care among type 2 diabetes patients with and without mental disorders during six-year follow-up in North Karelia, Finland. Methods: All type 2 diabetes patients (n = 10190) were analysed using the electronic health records data from 2011-12 to 2015-16. The diabetes care was evaluated using the measurement activity and the achievement of the treatment targets for HbA1c and LDL. Results: Monitoring of HbA1c and LDL levels improved among all patient groups, except the dementia patients. The proportion of those achieving the HbA1c target declined and those achieving the LDL target improved in all patient groups. Differences in the changes of achievement of the target HbA1c level among patients with dementia and depression were observed when compared with those having only type 2 diabetes. Conclusions: This study highlights the challenge of glucose level management as the age and comorbidities of the patients related to the care and achievements of the treatment targets. Mental disorders that are likely to affect patients' adherence to medication and other treatments should be taken into account and more support for self-care should be provided to such patients. Improvement in the achievement of LDL target address the progress in the prevention of macrovascular complications. (C) 2020 The Authors. Published by Elsevier B.V.Peer reviewe

Eroaako tyypin 1 diabeteksen hoito­ta­sa­paino perus­ter­vey­den­huol­lossa ja eri­kois­sai­raan­hoi­dossa?

Lähtö­kohdat Tyy­pin 1 diabe­teksen hoi­don kehit­tä­minen on jää­nyt tyy­pin 2 diabe­teksen var­joon. Tutki­muksen tarkoi­tuk­sena on alueel­lisen poti­las­tie­to­jär­jes­telmän avulla ar­vioida tyy­pin 1 diabe­tes­po­ti­laiden hoi­don toteu­tu­mista ­pe­rus­ter­vey­den­huol­lossa ja eri­kois­sai­raan­hoi­dossa Pohjois-Kar­ja­lassa. Mene­telmät Pohjois-Kar­ja­lassa on alueel­linen avo­ter­vey­den­huollon ja eri­kois­sai­raan­hoidon yh­teinen poti­las­tie­to­jär­jes­telmä Me­diatri. Tieto­jär­jes­tel­mästä poi­mittiin yli 20-vuo­tiaiden tyy­pin 1 diabe­tes­po­ti­laiden (n = 1 053) diabe­tekseen hoi­toon liit­tyvät tie­dot vuo­silta 2013–2014. Tie­tojen perus­teella ar­vioitiin tyy­pin 1 diabe­teksen hoi­don ­to­teu­tu­mista maakun­nassa. Tu­lokset Tyy­pin 1 diabee­ti­koista 73 % oli perus­ter­vey­den­huollon ja 27 % eri­kois­sai­raan­hoidon seuran­nassa. ­Eri­kois­sai­raan­hoidon seuran­nassa olevat diabee­tikot olivat keski­määrin nuo­rempia, ja heis­tä 44 % oli al­le 30-vuo­tiaita. Perus­ter­vey­den­huol­lossa taas 68 % seuran­nassa ol­leista diabee­ti­koista oli 40–60-vuo­tiaita. Keski­mää­räinen HbA1c-taso vuo­sina 2013–2014 oli 8,20 % (66,0 mmol/mol) ja me­diaani oli 8,05 % (64,5 mmol/mol). Ko­ko aineis­tosta 17,9 % saa­vutti HbA1c-ta­voitteen < 7 % (53 mmol/mol). Perus­ter­vey­den­huollon ja eri­kois­sai­raan­hoidon seuran­nassa olevien HbA1c-kes­kiar­voissa ei ol­lut eroa (8,17 ± 1,34 % vs. 8,27 ± 1,44 %; NS). Insu­lii­ni­pumppua käyttä­neillä HbA1c-kes­kiarvot olivat pa­remmat kuin moni­pis­tos­hoitoa käyttä­neillä (7,91 ± 0,99 % vs. 8,23 ± 1,40 %; p = 0,047). Pää­telmät Pohjois-Kar­ja­lassa tyy­pin 1 diabe­testa sairas­tavien ai­kuisten glu­koo­si­ta­sa­paino oli pa­rempi kuin aiem­missa suoma­lai­sissa rapor­teissa. Kui­tenkin vain al­le viide­sosa tyy­pin 1 diabee­ti­koista saa­vutti hoito­ta­voitteen. ­Hoi­to­ta­sa­pai­nossa ei ol­lut eroja sen mu­kaan, oliko po­tilas eri­kois­sai­raan­hoidon vai perus­ter­vey­den­huollon seuran­nassa, ja asian­mu­kainen lääke­hoito to­teutui hoito­pai­kasta riippu­matta. Hoi­don laa­tua on osaltaan ­var­mis­tanut Pohjois-Kar­ja­lassa diabe­teksen hoi­dossa vuosi­kym­menten ajan toteu­tunut pitkä­jän­teinen ­pe­rus­ter­vey­den­huollon ja eri­kois­sai­raan­hoidon verkos­toyh­teistyö

Electronic Health Records as Valuable Data Sources in the Health Care Quality Improvement Process

Background: In North Karelia, Finland, the regional electronic health records (EHRs) enable flexible data retrieval and area-level analyses. The aim of this study was to assess the early detection of type 2 diabetes (T2D) in the region and to evaluate the performed activities in order to improve the processes between the years 2012 and 2017. Methods: Patients with T2D were identified from the EHRs using the ICD-10 codes registered during any visit to either primary or specialized care. The prevalence of T2D was calculated for the years 2012, 2015, and 2017 on the municipality level. The number of people found in the EHRs with diabetes was compared with the number found in the national register of medication reimbursement rights. Results: In 2012, the age-adjusted prevalence of T2D in North Karelia varied considerably between municipalities (5.5%-8.6%). These differences indicate variation in the processes of early diagnosis. The findings were discussed in the regional network of health professionals treating patients with T2D, resulting in sharing experiences and best practices. In 2017, the differences had notably diminished, and in most municipalities, the prevalence exceeded 8%. The regional differences in the prevalence and their downward trend were observed both in the EHRs and in the medication reimbursement rights register. Conclusion: Clear differences in the prevalence of T2D were detected between municipalities. After visualizing these differences and providing information for the professionals, the early detection of T2D improved and the regional differences decreased. The EHRs are a valuable data source for knowledge-based management and quality improvement