[Quality of the treatment of type 2 diabetes: results from the GIANTT project 2004-2007].
OBJECTIVE
To describe the quality of diabetes care at the primary care level using the risk factors HbA1c, blood pressure and LDL cholesterol.


METHODS
Descriptive cohort study.


METHODS
Using data collected electronically from 124 Dutch general practitioners from the province of Groningen (north Netherlands), we assessed the medication treatment level in relation to the level of control for HbA1c, blood pressure and LDL cholesterol (adequate, moderate or inadequate control). Furthermore, we assessed treatment adjustments between 2004 and 2007 in insufficiently controlled patients (HbA1c value, systolic blood pressure or LDL cholesterol concentration too high).


RESULTS
Data were available for 9646 patients in 2007. The averages for HbA1c, systolic blood pressure and LDL cholesterol were 6.9%, 142 mmHg and 2.3 mmol/l, respectively. Of the patients with an HbA1c > 8.5%, 16% were treated with one oral drug and 50% used insulin. In 27% of these patients, the treatment was subsequently modified. Between 2004 and 2007, a slight decrease in average HbA1c was observed, but no changes in treatment level. Systolic blood pressure was >or= 140 mmHg in 56% of the patients, 19% of whom were not using antihypertensive drugs. Between 2004 and 2007 the average systolic blood pressure decreased by 6 mmHg, whereas the treatment level scarcely increased. Of the 39% of patients whose LDL cholesterol level was >or= 2.5 mmol/l, 49% did not use statins. In 2004 there was an increase in the percentage of patients using statins.


CONCLUSIONS
The decreasing population averages of HbA1c, systolic blood pressure and LDL cholesterol values suggest an improvement in the quality of care. However, the relatively few therapy modifications observed in insufficiently controlled patients indicates that there is still room for improvement.
Universitair Medisch Centrum Groningen, Afd. Klinische Farmacologie, Groningen, The Netherlands. j.voorham@med.umcg.nl
Jaco
J
Voorham
Flora M
FM
Haaijer-Ruskamp
Klaas
K
van der Meer
Dick
D
de Zeeuw
Bruce H R
BH
Wolffenbuttel
Klaas
K
Hoogenberg
Petra
P
Denig
D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D008078:Cholesterol, LDL / Q000097:blood; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D009426:Netherlands; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care; D012307:Risk Factors
D000924:Anticholesteremic Agents; D000959:Antihypertensive Agents; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents