Socioeconomic Differences in the Development and Prevention of Type 2 Diabetes : Focus on Education and Lifestyle

During recent decades, changes in society and environment have led to changes in lifestyle. As a result, risk factors for type 2 diabetes, such as obesity and physical inactivity, have increased in the population. Further, socioeconomic factors play a role in the development of type 2 diabetes. The aim of the present study was to examine the role of socioeconomic status in determining the risk factors, occurrence, comorbidities, and prevention of type 2 diabetes. The present study is based on three population-based, cross-sectional surveys (FIN-D2D, FINRISK and AVTK), and one clinical, longitudinal, randomized intervention study (DPS). When appropriate, the incident diagnoses of type 2 diabetes and other chronic diseases were identified through linkage with the national registers on reimbursement rights, hospitalizations, and mortality. Hyperglycaemia was more common among those with low education compared with those with medium and high education. The incidence of type 2 diabetes has increased among Finnish men, but not among women, and has occurred predominantly among men with low and middle educational attainment. Obesity explained some but not all of this variation between socioeconomic classes. On the other hand, no evidence was found to suggest that low socioeconomic status increases the development of comorbidities among people with diabetes or decreases the effectiveness of lifestyle intervention aiming to prevent type 2 diabetes among people at risk. Furthermore, the national diabetes prevention programme succeeded in increasing awareness of type 2 diabetes among the population, regardless of socioeconomic status. This study provides knowledge to support future activities to prevent type 2 diabetes and other chronic diseases and suggests that interventions can diminish health disparities.Tyypin 2 diabetes on yleistynyt nopeasti suomalaisessa väestössä viime vuosikymmeninä. Lisääntymisen ajatellaan johtuvan pitkälti lihavuuden yleistymisestä, liikunnan vähentymisestä, ja väestön ikääntymisestä. Myös sosioekonomiset tekijät ovat yhteydessä tyypin 2 diabeteksen kehittymiseen. Tämän tutkimuksen tavoitteena oli selvittää sosioekonomisia eroja tyypin 2 diabeteksen, sen riskitekijöiden ja lisäsairauksien esiintymisessä sekä ehkäisytoimien vaikuttavuudessa. Tutkimuksessa käytettiin useiden väestöpohjaisten, poikkileikkaustutkimusten aineistoja (FIN-D2D, FINRISKI ja AVTK) sekä satunnaistetun Diabeteksen ehkäisytutkimuksen (DPS) aineistoa. Tiedot diabeteksen ja sen lisäsairauksien ilmaantuvuudesta seuranta-aikana saatiin yhdistämällä tutkimusaineistoihin kansallisen erityislääkekorvaus-, hoitoilmoitus- ja kuolinsyyrekisterin tietoja. Tutkimuksen mukaan tyypin 2 diabetes on yleisempää alemmissa koulutusryhmissä kuin ylimmässä koulutusryhmässä, ja havaittua yhteyttä selittävät tunnetut riskitekijät, erityisesti lihavuus. Taudin ilmaantuvuus eli uusien sairastuneiden määrä tuhatta henkilöä kohti vuodessa on suurentunut viime vuosikymmeninä erityisesti alimman koulutusryhmän miehillä, joilla myös lihavuus on yleistynyt eniten. Naisilla diabeteksen ilmaantuvuus ei sen sijaan ole suurentunut. Monet riskitekijät ennustavat myös diabeteksen lisäsairauksien ilmaantuvuutta, mutta koulutustaustan ei havaittu olevan yhteydessä lisäsairauksien ilmaantuvuuteen. Tulokset osoittavat tyypin 2 diabeteksen ehkäisytoimenpiteiden toimivan kaikissa koulutusryhmissä, niin korkean diabetesriskin henkilöillä kuin väestössä ylipäätään. Tieto tukee niiden toimenpiteiden kehittämistä ja suuntaamista, joilla pyritään ehkäisemään tyypin 2 diabetesta ja kaventamaan terveyseroja suomalaisessa väestössä

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

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

Quality indicators for diabetes prevention programs in health care

Objective. Type 2 diabetes can be efficiently prevented by lifestyle intervention provided for people at high diabetes risk. The aim of this paper was to conduct a literature search on existing quality indicators for type 2 diabetes prevention and to collate and present a set of indicators that could be applied in uropean countries with different health care systems and cultures. Methods. Scientific and grey literature was searched for relevant studies using electronic databases. We also hand searched previous systematic reviews and reference lists of relevant articles. Results. The only publication identified was the report presenting the results from the IMAGE project. The IMAGE indicators were used as the basis for the proposed indicators. Conclusions. Publications on quality indicators of diabetes prevention programmes are scarce. The quality indicators presented here are a first step toward the definition of a core set of European indicators to monitor and improve the quality of diabetes prevention