Quality improvement of metabolic control for patients with type 2 diabetes treated at a general hospital: a quantitative open cohort study

J Eval Clin Pract. 2014 Aug;20(4):429-35. doi: 10.1111/jep.12168. Epub 2014 May 15.

Abstract

Rationale, aims and objectives: Most patients with type 2 diabetes have metabolic risk factors above recommend goals. The present intervention aimed to escalate medical treatment to improve metabolic control. The study was carried out at a Norwegian general hospital as a quantitative open cohort study.

Methods: The audit evaluated 191 patients treated from 2007 to 2012. To improve metabolic control, a medical intervention used stepped care and goals for the metabolic risk factors. A database was used to overview the intervention. Multiple regression analyses assessed whether baseline characteristics and components of the intervention were associated with change of metabolic risk factors.

Results: The intervention increased number of antihypertensive drugs and dose of metformin and insulin. The intensification lowered mean systolic blood pressure from 142 to 132 mmHg, low-density lipoprotein cholesterol from 2.6 to 2.1 mmol L(-1) and glycated haemoglobin, HbA1c, from 8.5 to 7.6% (64-57 mmol mol(-1) , P < 0.001, t-tests). At end of the study, 25 (13%) patients fulfilled targets for the three metabolic risk factors. Multiple linear regression analyses showed that changes of the three metabolic risk factors were significantly associated with levels at start of the study and number of visits or length of follow-up.

Conclusions: Stepped care was an effective treatment for type 2 diabetes at a general hospital. The database supported the intervention. It improved metabolic control over 4 years.

Keywords: cardiovascular risk; database; intervention; multiple linear regression; quality improvement; type 2 diabetes.

MeSH terms

  • Adult
  • Aged
  • Antihypertensive Agents / therapeutic use
  • Cohort Studies
  • Databases, Factual
  • Diabetes Complications / prevention & control
  • Diabetes Mellitus, Type 2 / drug therapy
  • Diabetes Mellitus, Type 2 / metabolism*
  • Female
  • Glycated Hemoglobin / metabolism
  • Hospitals, General*
  • Humans
  • Hypolipidemic Agents / therapeutic use
  • Male
  • Middle Aged
  • Norway
  • Practice Patterns, Physicians'
  • Quality Improvement*
  • Regression Analysis

Substances

  • Antihypertensive Agents
  • Glycated Hemoglobin A
  • Hypolipidemic Agents