(84) Comparing Diabetes Care Outcomes of The Centrally Organized Hoorn Diabetes Care System with Regular Care by General Practitioners in the Netherlands

Publication Number: 1129

Background: In the Netherlands general practitioners (GPs) are responsible for primary type 2 diabetes (T2D)-care. To improve the quality of care, the Diabetes Care System (DCS) was set up in the West-Friesland region of the Netherlands. The DCS-centre was responsible for the quality of T2D-care and performed centrally organized, annual, standardized assessments. In 2014 saving measures in DCS were introduced.

Objectives: To compare diabetes care outcomes between patients treated in DCS and those in regular T2D-care in 2013.

Methods: A retrospective observational study was performed in the DIAbetes MANagement and Treatment (DIAMANT) cohort, a population-based, dynamic, prospective cohort of persons with diabetes, derived from electronic medical records from Dutch GPs from the PHARMO Database Network. Data from 2013 were extracted. Logistic regression analysis was performed to compare medication use between the DCS-group (cases) and the regular T2D-care group (controls); negative binomial regression to compare the number of examinations per year, and multivariable ordinal logistic regression to compare proportions on target for glycated haemoglobin (HbA1c) and normal renal function.

Results: 131,154 patients were included in the DIAMANT-cohort in 2013, of whom 7,593 were treated in DCS. Age, age-at-diagnosis, and sex were similar between groups. DCS-cases were less likely to use the newer glucose-lowering drugs dipeptidylpeptidase-4 (DPP4)-inhibitors (OR 0.26, 95%CI 0.21-0.32) and glucose-like peptide-1 (GLP1)-receptor antagonists (OR 0.18, 95%CI 0.25-1.34) compared to controls. Also the total number of glucose-lowering drugs used was lower in DCS-cases (OR 0.86, 95%CI 0.82-0.90).
The number of examinations (OR 0.85, 95%CI 0.84-0.87) and GP-consults (OR 0.92, 95%CI 0.91-0.94) was lower in DCS-cases. Furthermore, the use of antihypertensives (OR 0.38, 95%CI 0.29-0.49), RAAS-agents (0.76, 95%CI 0.73-0.80) and calcium channel blockers (OR 0.82, 95%CI 0.77-0.87) was lower in DCS-cases, whereas the use of diuretics, beta blockers and lipid-modifying drugs was similar between the two groups.
HbA1c-levels in DCS-cases compared to controls were lower (OR 0.69, 95%CI 0.67-0.71); the proportion of patients on target for HbA1c was similar in both groups, as was the proportion with normal renal function.

Conclusions: In 2013, T2D care in DCS was less intensive than in regular T2D care, in terms of number of examinations and consults. In addition, less newer antidiabetic and antihypertensive medication was use, whereas the proportion of patients on target for HbA1c was similar. Difference in registration between DCS and regular T2D-care might have introduced bias.