Kristina B Slåtsve1,2, Tor Claudi1, Knut T Lappegård1,2, Anne K Jenum3, Marthe Larsen4, Kjersti Nøkleby5, John G Cooper6,7, Sverre Sandberg7,8,9, Tore J Berg10,11. 1. Department of Medicine, Nordland Hospital, Bodø, Norway. 2. Department of Clinical Medicine, UiT, The Arctic University of Norway, Tromsø, Norway. 3. General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway. 4. Clinical Research Department, University Hospital of North Norway, Tromsø, Norway. 5. Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway. 6. Department of Medicine, Stavanger University Hospital, Stavanger, Norway. 7. Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway. 8. Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway. 9. Department of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway. 10. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. 11. Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.
Abstract
AIMS: The objectives of this study are to identify the proportion and characteristics of people with type 1 and 2 diabetes treated in primary, specialist and shared care and to identify the proportion of persons with type 2 diabetes reaching HbA1c treatment targets and the clinical risk factors and general practitioner and practice characteristics associated with treatment in specialist care. METHODS: Population-based cross-sectional study including all adults ≥18 years diagnosed with diabetes in primary and specialist care in Salten, Norway. We used multivariable mixed-effects logistic regression models with level of care as outcome variable and population, general practitioner, and practice characteristics as exposure variables. RESULTS: Of 2704 people with type 2 diabetes, 13.5% were treated in shared care and 2.1% in specialist care only. Of 305 people with type 1 diabetes, 14.4% received treatment in primary care only. The HbA1c treatment target of 53 mmol/mol (7.0%) was reached by 67.3% of people with type 2 diabetes in primary care versus 30.4% in specialist care. HbA1c , use of insulin, coronary heart disease, retinopathy and urban practice location were positively associated with treatment in specialist care. General practitioners' use of a structured form and a diabetes nurse were negatively associated with specialist care. CONCLUSIONS: Of people with type 2 diabetes, 16% were treated in specialist care. They had higher HbA1c and more vascular complications, as expected from priority guidelines. The use of a structured diabetes form and diabetes nurses seem to support type 2 diabetes follow-up in primary care.
AIMS: The objectives of this study are to identify the proportion and characteristics of people with type 1 and 2 diabetes treated in primary, specialist and shared care and to identify the proportion of persons with type 2 diabetes reaching HbA1c treatment targets and the clinical risk factors and general practitioner and practice characteristics associated with treatment in specialist care. METHODS: Population-based cross-sectional study including all adults ≥18 years diagnosed with diabetes in primary and specialist care in Salten, Norway. We used multivariable mixed-effects logistic regression models with level of care as outcome variable and population, general practitioner, and practice characteristics as exposure variables. RESULTS: Of 2704 people with type 2 diabetes, 13.5% were treated in shared care and 2.1% in specialist care only. Of 305 people with type 1 diabetes, 14.4% received treatment in primary care only. The HbA1c treatment target of 53 mmol/mol (7.0%) was reached by 67.3% of people with type 2 diabetes in primary care versus 30.4% in specialist care. HbA1c , use of insulin, coronary heart disease, retinopathy and urban practice location were positively associated with treatment in specialist care. General practitioners' use of a structured form and a diabetes nurse were negatively associated with specialist care. CONCLUSIONS: Of people with type 2 diabetes, 16% were treated in specialist care. They had higher HbA1c and more vascular complications, as expected from priority guidelines. The use of a structured diabetes form and diabetes nurses seem to support type 2 diabetes follow-up in primary care.
Authors: Kristina B Slåtsve; Tor Claudi; Knut Tore Lappegård; Anne Karen Jenum; Marthe Larsen; Kjersti Nøkleby; Katrina Tibballs; John G Cooper; Sverre Sandberg; Esben Selmer Buhl; Karianne Fjeld Løvaas; Tore Julsrud Berg Journal: BMJ Open Diabetes Res Care Date: 2022-09