The National Diabetes Register in Sweden: an implementation of the St. Vincent Declaration for Quality Improvement in Diabetes Care
2003 (English)In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 26, no 4, 1270-1276 p.Article in journal (Refereed) Published
OBJECTIVE:To monitor glycemic control, treatable risk factors, and treatment profile for quality assessment of diabetes care on a national scale.
RESEARCH DESIGN AND METHODS:Four samples of 23,546, 32,903, 30,311, and 29,769 patients with diabetes (1996-1999) were studied based on a repeated national screening and quality assessment of diabetes care by the National Diabetes Register, Sweden, with participation of both hospitals and primary health care. Clinical characteristics included were age, sex, diabetes duration and treatment, glycemic control (HbA(1c)), office blood pressure (BP), BMI, smoking habits, and use of lipid-lowering drugs in patients with type 1 or type 2 diabetes.
RESULTS:Favorable decreases of mean HbA(1c) and BP values were registered during the 4-year study period for both type 1 (HbA(1c) 7.5-7.3% and BP 130/75-130/74 mmHg) and type 2 diabetic patients (HbA(1c) 7.0-6.7% and BP 151/82-147/80 mmHg). Treatment aims of HbA(1c) and BP levels were also achieved in increasing proportions for type 1 (HbA(1c) <7.5%: 50-58% and BP </=140/85 mmHg: 77-79%), and type 2 diabetic patients (HbA(1c) <7.5%: 66-73% and BP </=140/85 mmHg: 32-42%). The use of lipid-lowering drugs increased for type 1 (4-11%) and type 2 diabetic patients (10-22%). In type 2 diabetic patients, treatment with oral agents alone decreased, but combination therapy (insulin and oral agents) increased during the study period. Mean BMI increased during 1996-1999 in type 2 diabetic patients. High HbA(1c) and BP values in 1999 were predicted by high BMI values 1996 and by high increase of BMI during the period, independent of diabetes duration, age, and sex.
CONCLUSIONS:Decreasing mean HbA(1c) and BP levels and the wider use of lipid-lowering drugs during the late 1990s in patients with diabetes in a national sample from Sweden should translate into clinical benefits regarding micro- and macrovascular complications as well as diabetes-related mortality.
Place, publisher, year, edition, pages
2003. Vol. 26, no 4, 1270-1276 p.
Adult, Age of Onset, Antilipemic Agents/therapeutic use, Blood Glucose/metabolism, Delivery of Health Care/*standards, Diabetes Mellitus/*epidemiology/prevention & control/*therapy, Diabetes Mellitus; Type 1/epidemiology, Diabetes Mellitus; Type 2/epidemiology, Female, Humans, Male, Middle Aged, Multivariate Analysis, Obesity, Quality Assurance; Health Care, Registries, Risk Factors, Smoking, Sweden/epidemiology
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:uu:diva-10362DOI: 10.2337/diacare.26.4.1270ISI: 000185505300051PubMedID: 12663609OAI: oai:DiVA.org:uu-10362DiVA: diva2:38130