Effect of a Disease Management Program on the Adherence to Guideline-Recommended HbA1c Monitoring in Patients with Diabetes in Slovakia
Tóm tắt
Glycated hemoglobin (HbA1c) is a crucial marker of glucose control that is widely utilized in the management of diabetes mellitus. The aim of this study was to evaluate the effect of a diabetes management program (DMP) offered by a health insurance company, together with the effects of other factors associated with patient and physician characteristics, on the frequency of HbA1c testing in outpatient diabetes clinics in Slovakia. A retrospective analysis was conducted to compare the frequency of HbA1c measurements in patients under the care of physicians participating in the DMP with those who did not, spanning the years 2015 to 2019. In 2019, a total of 74,384 patients with diabetes were included in the analysis, of which 52% were men and 48% were women, with an average age of 64.1 years. At the end of the study period, the average annual number of HbA1c measurements was significantly higher in patients treated by physicians participating in the DMP than in patients treated by physicians who were not (2.50 vs. 1.91 per year, respectively; P < 0.001). There was a substantial increase in HbA1c testing at least twice yearly in both groups, but the growth rate was greater in the group with DMP-engaged diabetologists (14.3%) compared to the diabetes specialists who were not involved in the DMP (5.1%). In the multivariate analysis, participation in the DMP was correlated with an increase in HbA1c tests per year by 0.7. Physician participation in a DMP was found to significantly increase the number of HbA1c tests ordered by physicians, potentially leading to improved glycemic control.
Tài liệu tham khảo
McCarter RJ, Hempe JM, Chalew SA. Mean blood glucose and biological variation have greater influence on HbA1c levels than glucose instability: an analysis of data from the diabetes control and complications trial. Diabetes Care. 2006;29:352–5.
Cohen RM, Smith EP. Frequency of HbA1c discordance in estimating blood glucose control. Curr Opin Clin Nutr Metab Care. 2008;11:512–7. https://doi.org/10.1097/MCO.0b013e32830467bd.
Diabetes Control and Complications Trial Research Group, Nathan DM, Genuth S, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–86. https://doi.org/10.1056/NEJM199309303291401.
UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–53. https://doi.org/10.1016/S0140-6736(98)07019-6.
Khaw KT, Wareham N. Glycated hemoglobin as a marker of cardiovascular risk. Curr Opin Lipidol. 2006;17:637–43. https://doi.org/10.1097/MOL.0b013e3280106b95.
Martinka E (ed). Interdisciplinary recommendations for the diagnosis and treatment of diabetes mellitus, its complications and most significant comorbidities—2021. Forum Diab. 2021;10(Suppl 2):1-279. https://www.prolekare.cz/casopisy/forum-diabetologicum/2021-supplementum-2-2/download?hl=cs.
National Health Information Center (NHIC). Activity of diabetes clinics in the Slovak Republic 2020. Health statistics yearbook 2020. 2021. https://www.nczisk.sk/Documents/rocenky/2020/Zdravotnicka_rocenka_Slovenskej_republiky_2020.pdf. Accessed 22 Feb 2022.
Ministry of Health of the Slovak Republic. Bulletins of the Ministry of Health of the Slovak Republic 2011. Volume 59. https://www.health.gov.sk/?VestnikyMzSr2011. Accessed 22 Feb 2022.
Steuten LMG, Vrijhoef HJM, Landewé-Cleuren S, et al. A disease management programme for patients with diabetes mellitus is associated with improved quality of care within existing budgets. Diabet Med. 2007;24:1112–20. https://doi.org/10.1111/j.1464-5491.2007.02202.x.
Kostev K, Rockel T, Jacob L. Impact of disease management programs on HbA1c values in type 2 diabetes patients in Germany. J Diab Sci Technol. 2017;11:117–22. https://doi.org/10.1177/1932296816651633.
Sidorov J, Gabbay R, Harris R, et al. Disease management for diabetes mellitus: impact on hemoglobin A1c. Am J Manag Care. 2000;6:1217–26.
Shojania KG, Ranji SR, Mcdonald KM, et al. Effects of quality improvement strategies for type 2 diabetes on glycemic control: a meta-regression analysis. J Am Med Assoc. 2006;296:427–40. https://doi.org/10.1001/jama.296.4.427.
Tulejová H, Mužik R, Martinka E, Uličiansky V. Disease management programmes An opportunity to improve diabetes care. Int Med. 2017;17:259–64.
Fu C, Ji L, Wang W. Frequency of glycated hemoglobin monitoring was inversely associated with glycemic control of patients with type 2 diabetes mellitus. J Endocrinol Invest. 2012;35:269–73. https://doi.org/10.3275/7743.
Schwandt A, Best F, Biester T, et al. Both the frequency of HbA1c testing and the frequency of self-monitoring of blood glucose predict metabolic control: a multicentre analysis of 15 199 adult type 1 diabetes patients from Germany and Austria. Diabetes Metab Res Rev. 2017;33:7. https://doi.org/10.1002/dmrr.2908.
García AB, Vega JS, Vigara JCR, et al. Prevalence of diabetes and frequency of glycated haemoglobin monitoring in Extremadura (Spain) during 2012, 2013 and 2014: an observational study. Prim Care Diabetes. 2019;13:324–9. https://doi.org/10.1016/j.pcd.2018.12.006.
Lyon AW, Higgins T, Wesenberg JC, et al. Variation in the frequency of hemoglobina1c (HbA1c) testing: population studies used to assess compliance with clinical practice guidelines and use of hba1c to screen for diabetes. J Diab Sci Technol. 2009;3:411–7. https://doi.org/10.1177/193229680900300302.
Kostev K, Jacob L, Lucas A, Rathmann W. Low annual frequency of HbA1c testing in people with type 2 diabetes in primary care practices in Germany. Diabet Med. 2018;35:249–54. https://doi.org/10.1111/dme.13556.
Ohde S, Deshpande GA, Yokomichi H, et al. HbA1c monitoring interval in patients on treatment for stable type 2 diabetes. A ten-year retrospective, open cohort study. Diabetes Res Clin Pract. 2018;135:166–71. https://doi.org/10.1016/j.diabres.2017.11.013.
Yoo KH, Shin DW, Cho MH, Kim SH, et al. Regional variations in frequency of glycosylated hemoglobin (HbA1c) monitoring in Korea: a multilevel analysis of nationwide data. Diab Res Clin Pract. 2017;131:61–9. https://doi.org/10.1016/j.diabres.2017.06.008.
Imai C, Li L, Hardie R-A, Georgiou A. Adherence to guideline-recommended HbA1c testingfrequency and better outcomes in patients with type 2 diabetes: a 5-year retrospective cohort study in Australian general practice. BMJ Qual Saf. 2021;30:706–14. https://doi.org/10.1036/bmjqs-2020-012026.