Quality improvement of metabolic control for patients with type 2 diabetes treated at a general hospital: a quantitative open cohort study.
OBJECTIVE
Most patients with type 2 diabetes have metabolic risk factors above recommend goals. The present intervention aimed to escalate medical treatment to improve metabolic control. The study was carried out at a Norwegian general hospital as a quantitative open cohort study.


METHODS
The audit evaluated 191 patients treated from 2007 to 2012. To improve metabolic control, a medical intervention used stepped care and goals for the metabolic risk factors. A database was used to overview the intervention. Multiple regression analyses assessed whether baseline characteristics and components of the intervention were associated with change of metabolic risk factors.


RESULTS
The intervention increased number of antihypertensive drugs and dose of metformin and insulin. The intensification lowered mean systolic blood pressure from 142 to 132 mmHg, low-density lipoprotein cholesterol from 2.6 to 2.1 mmol L(-1) and glycated haemoglobin, HbA1c, from 8.5 to 7.6% (64-57 mmol mol(-1) , P < 0.001, t-tests). At end of the study, 25 (13%) patients fulfilled targets for the three metabolic risk factors. Multiple linear regression analyses showed that changes of the three metabolic risk factors were significantly associated with levels at start of the study and number of visits or length of follow-up.


CONCLUSIONS
Stepped care was an effective treatment for type 2 diabetes at a general hospital. The database supported the intervention. It improved metabolic control over 4 years.
Center of Tobacco Control Research, Odense, Denmark.
Finn Edler
FE
von Eyben
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015331:Cohort Studies; D016208:Databases, Factual; D048909:Diabetes Complications / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000378:metabolism*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006769:Hospitals, General; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009664:Norway; D010818:Practice Patterns, Physicians'; D058996:Quality Improvement; D012044:Regression Analysis
D000959:Antihypertensive Agents; D006442:Glycated Hemoglobin; D000960:Hypolipidemic Agents
cardiovascular risk; database; intervention; multiple linear regression; quality improvement; type 2 diabetes