title: Care trajectories are associated with quality improvement in the treatment of patients with uncontrolled type 2 diabetes: A registry based cohort study.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of General Practice, Katholieke Universiteit Leuven, Leuven, Belgium. Electronic address: geert.goderis@med.kuleuven.be.
authors.forename: Geert
authors.initials: G
authors.lastname: Goderis
authors.affiliation: Unit Health Services Research, Scientific Institute of Public Health, Brussels, Belgium.
authors.forename: Viviane
authors.initials: V
authors.lastname: Van Casteren
authors.affiliation: Faculty of Public Health, Université Catholique de Louvain, Louvain-la-Neuve, Belgium.
authors.forename: Etienne
authors.initials: E
authors.lastname: Declercq
authors.affiliation: Unit Health Services Research, Scientific Institute of Public Health, Brussels, Belgium.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Bossuyt
authors.affiliation: Department of General Practice, Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: Carine
authors.initials: C
authors.lastname: Van Den Broeke
authors.affiliation: Unit Health Services Research, Scientific Institute of Public Health, Brussels, Belgium.
authors.forename: Katrien
authors.initials: K
authors.lastname: Vanthomme
authors.affiliation: Unit Health Services Research, Scientific Institute of Public Health, Brussels, Belgium.
authors.forename: Sarah
authors.initials: S
authors.lastname: Moreels
authors.affiliation: OLV Hospital Aalst, Aalst, Belgium.
authors.forename: Frank
authors.initials: F
authors.lastname: Nobels
authors.affiliation: Endocrinology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Chantal
authors.initials: C
authors.lastname: Mathieu
authors.affiliation: Department of General Practice, Katholieke Universiteit Leuven, Leuven, Belgium; Department of General Practice, Maastricht University, Maastricht, The Netherlands.
authors.forename: Frank
authors.initials: F
authors.lastname: Buntinx
mesh_terms: D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001530:Belgium / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D008078:Cholesterol, LDL / Q000097:blood; D019091:Critical Pathways; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D058006:General Practice; D052216:Glucagon-Like Peptide 1 / Q000008:administration & dosage* / Q000031:analogs & derivatives; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D054795:Incretins / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D001786:Blood Glucose; D008078:Cholesterol, LDL; D052216:Glucagon-Like Peptide 1; D006442:Glycated Hemoglobin; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents; D054795:Incretins; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: Chronic disease management; Effectiveness; Quality of care; Retrospective cohort study; Type 2 diabetes mellitus