(26) Type 2 Diabetes, The Epidemic: Trends in Prevalence, Treatment and Risk-Factor Control, 2004-2020

Publication Number: 357

Background: To better understand the impact of type 2 diabetes (T2D), data on reliable trends regarding prevalence are key. In addition, it is also vital to know trends in antidiabetic treatment and risk-factor control among people with T2D. Such recent data from European people with T2D are not published yet.

Objectives: To update national trends in the prevalence of T2D in the Netherlands for the period 2004-2020 and to assess trends in treatment and risk-factor control.

Methods: The DIAbetes, MANagement and Treatment (DIAMANT) cohort was used to calculate prevalence, treatment and risk-factor control over time (2004-2020). DIAMANT is a large and complete population-based, dynamic, prospective cohort of persons with diabetes, derived from electronic medical records from Dutch general practitioners that have given consent to extract their regular care electronic file in the PHARMO General Practitioner (GP) Database for research purposes. A cross-sectional design was used, which was repeated each year for the duration of the study period. Prevalence was calculated by dividing the total number of people with T2D in the DIAMANT cohort by the total number of residents in PHARMO’s GP Database. All antidiabetic prescriptions were converted into treatment episodes of continuous use to determine treatment. For risk-factor control, the last measurement (glycated haemoglobin level [HbA1c], low-density lipoprotein [LDL], systolic [SBP] and diastolic blood pressure [DBP]) in the year prior to the year of interest was used. Descriptive statistics were used for all analyses.

Results: The number of residents in PHARMO’s GP Database (e.g. population size) increased from nearly 950.000 in 2004 to >3.200.000 in 2020. The number of people with T2D increased from >21.000 in 2004 to >185.000 in 2020. The prevalence of T2D in the Netherlands increased from 2.3% in 2004 to 5.8% in 2020. The proportion of persons with T2D who used any antidiabetic treatment increased from 21% in 2004 to 58% in 2020. Glycaemic control (HbA1c ≤53 mmol/mol) increased from 19.9% in 2004 to 53.5% in 2014, after which it decreased to 46.8% in 2020. Lipid control (LDL ≤2.6 mmol/l) increased from 8.7% in 2004 to 40.7% in 2012, after which the increase levelled off (to 50.0% in 2020). BP control (≤140/90 mmHg) increased from 11.3% in 2004 to 45.6% in 2012, after which the increase levelled off (to 53.7% in 2020).

Conclusions: During 2004-2020, the prevalence of T2D in the Netherlands more than doubled. The proportion of patients using any antidiabetic treatment increased steadily throughout the study period. Diabetes risk-factor control improved from 2004 to the early 2010s but subsequently declined or stagnated.