TY - JOUR T1 - Care trajectories are associated with quality improvement in the treatment of patients with uncontrolled type 2 diabetes: A registry based cohort study. JF - Prim Care Diabetes Y1 - 2015 A1 - Goderis, Geert A1 - Viviane Van Casteren A1 - Declercq, Etienne A1 - Nathalie Bossuyt A1 - Van Den Broeke, Carine A1 - Vanthomme, Katrien A1 - S Moreels A1 - Nobels, Frank A1 - Mathieu, Chantal A1 - Buntinx, Frank KW - Aged KW - Angiotensin II Type 1 Receptor Blockers KW - Angiotensin-Converting Enzyme Inhibitors KW - Belgium KW - Biomarkers KW - Blood Glucose KW - Cholesterol, LDL KW - Critical Pathways KW - Diabetes Mellitus, Type 2 KW - Diabetic Angiopathies KW - Female KW - General practice KW - Glucagon-Like Peptide 1 KW - Hemoglobin A, Glycosylated KW - Humans KW - Hydroxymethylglutaryl-CoA Reductase Inhibitors KW - Hypoglycemic Agents KW - Incretins KW - Insulin KW - Linear Models KW - Logistic Models KW - Male KW - ODDS RATIO KW - quality improvement KW - Quality Indicators, Health Care KW - REGISTRIES KW - Retrospective Studies KW - Risk Factors KW - Time Factors KW - Treatment Outcome AB -

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. 98mg/dl), 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.

VL - 9 CP - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25709079?dopt=Abstract M3 - 10.1016/j.pcd.2015.01.008 ER -