Type 2 diabetes in general practice in Norway 2005–2014: moderate improvements in risk factor control but still major gaps in complication screening

Abstract

ObjectiveTo assess the status of type 2 diabetes care in general practice and changes in the quality of care between 2005 and 2014, and to identify areas of diabetes care requiring improvement.Research design and methodsTwo cross-sectional surveys were performed that included patients with type 2 diabetes in selected areas (n=9464 in 2014, n=5463 in 2005). Quality of care was assessed based on key recommendations in national guidelines. Differences in clinical performance between 2005 and 2014 were assessed in regression models adjusting for age, sex, counties and clustering within general practices.ResultsTreatment targets were achieved in a higher proportion of patients in 2014 compared with 2005: hemoglobin A1c ≤7.0% (≤53 mmol/mol) in 62.8% vs 54.3%, blood pressure ≤135/80 mm Hg in 44.9% vs 36.6%, and total cholesterol ≤4.5 mmol/L in 49.9% vs 33.5% (all adjusted P≤0.001). Regarding screening procedures for microvascular complications, fewer patients had recorded an eye examination (61.0% vs 71.5%, adjusted P<0.001), whereas more patients underwent monofilament test (25.9% vs 18.7%, adjusted P<0.001). Testing for albuminuria remained low (30.3%) in 2014. A still high percentage were current smokers (22.7%).ConclusionsWe found moderate improvements in risk factor control for patients with type 2 diabetes in general practice during the last decade, which are similar to improvements reported in other countries. We report major gaps in the performance of recommended screening procedures to detect microvascular complications. The proportion of daily smokers remains high. We suggest incentives to promote further improvements in diabetes care in Norway.

Population, general practitioner and practice characteristics are associated with screening procedures for microvascular complications in Type 2 diabetes care in Norway

“…The ROSA 4 study is a large population‐based cross‐sectional study of diabetes care in Norwegian general practice that collected data from 2014 . We invited GP practices located in five of Norway's 19 counties including urban and rural areas.…”

“…Recently, we assessed the quality of care for~9500 people with Type 2 diabetes in general practice in Norway in 2014 using data from the Rogaland-Oslo-Salten-Akershus-Hordaland study (ROSA 4 study) [9]. Measurements of HbA 1c , blood pressure, lipids and eGFR were available for $ 90% of people assessed, and the achievement of treatment targets were comparable with reports from other countries.…”

Decreasing incidence of pharmacologically and non-pharmacologically treated type 2 diabetes in Norway: a nationwide study

“…Although the majority of people with type 2 diabetes receive pharmacological treatment [ 4 – 6 ], a proportion of adults with type 2 diabetes (20–40%) are omitted from analyses when only pharmacologically treated individuals are included [ 7 – 10 ]. Thus, differences over time in treatment patterns have not been covered by previous studies.…”

The roles of healthcare professionals in diabetes care: a qualitative study in Norwegian general practice

“…end-stage renal disease, blindness and amputations) are largely preventable and related to lifestyle [59]. Based on Norwegian register data and data from electronic medical records, only 9.8% of patients with T1DM and 16% of patients with T2DM achieve combined treatment targets for HbA1c, blood pressure and cholesterol [60,61]. Furthermore, a recent study from general practice found that only 5% of patients with T2DM and coronary heart disease reach the four main treatment targets (no smoking, HbA1c 7.0%, SBP 135 mmHg, LDL-cholesterol 1.8 mmol/l) [62].…”