title: Sex Differences in the Quality of Diabetes Care in the Netherlands (ZODIAC-45).
abstract: OBJECTIVE
  Our aim was to investigate whether trends in quality of diabetes care differ between sexes in the Netherlands from 1998 till 2013.
  
  
  METHODS
  In this prospective observational cohort study quality of care was measured using process and outcome measures in patients with type 2 diabetes in primary care. Trend and absolute differences between sexes were investigated for patients <75 years. Subgroup analyses were performed in patients ≥75 years. 10-year mortality risk was assessed with the Globorisk risk equation in patients without cardiovascular diseases <75 years.
  
  
  RESULTS
  The number of patients increased from 2,644 in 1998 to 62,230 in 2013. In 1998, 51% of the men and 60% of the women <75 years had an HbA1c >53 mmol/mol; this decreased to approximately 29% in both sexes in 2013. Patients having a systolic blood pressure >140 mmHg decreased from 70% to 42%, and from 80% to 40% in men and women <75 years, respectively. In patients ≥75 years it decreased from 72% to 50% in men and 85% to 56% in women. Obesity increased in both sexes, whereas smoking in men and women declined in patients <75 years (men: 34% to 22%; women: 22% to 18%). The number of patients with a mortality risk >20% over 10 years decreased from 15% to 3% in men and from 18% to 3% in women.
  
  
  CONCLUSIONS
  Quality of diabetes care has improved considerably in the period 1998-2013 in both sexes. Possibly relevant trend differences between sexes were observed for HbA1c, systolic blood pressure, BMI and smoking. The predicted mortality risk decreased over time in both sexes. Except for BMI in both age groups and systolic blood pressure in patients ≥75 years, no evident poorer risk factor control in women compared to men was found at the end of the study period.
authors.affiliation: Diabetes Centre, Isala, Zwolle, the Netherlands.
authors.forename: Steven H
authors.initials: SH
authors.lastname: Hendriks
authors.affiliation: Diabetes Centre, Isala, Zwolle, the Netherlands.
authors.forename: Kornelis J J
authors.initials: KJ
authors.lastname: van Hateren
authors.affiliation: Department of General Practice, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Klaas H
authors.initials: KH
authors.lastname: Groenier
authors.affiliation: Diabetes Centre, Isala, Zwolle, the Netherlands.|Langerhans Medical Research Group, Zwolle, the Netherlands.
authors.forename: Sebastiaan T
authors.initials: ST
authors.lastname: Houweling
authors.affiliation: Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: Angela H E M
authors.initials: AH
authors.lastname: Maas
authors.affiliation: Diabetes Centre, Isala, Zwolle, the Netherlands.|Langerhans Medical Research Group, Zwolle, the Netherlands.|Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Nanne
authors.initials: N
authors.lastname: Kleefstra
authors.affiliation: Diabetes Centre, Isala, Zwolle, the Netherlands.|Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands.|Department of Internal Medicine, Isala, Zwolle, the Netherlands.
authors.forename: Henk J G
authors.initials: HJ
authors.lastname: Bilo
mesh_terms: D000368:Aged; D001794:Blood Pressure; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011787:Quality of Health Care / Q000706:statistics & numerical data* / Q000639:trends; D012737:Sex Factors; D012907:Smoking; D016896:Treatment Outcome
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human