Evaluation of diabetes care in the Otago region using a diabetes register, 1998–2003

Abstract

Aim: To assess changes in diabetes care between 1998 and 2003 using data from the Otago Diabetes Register. Methods: A regional diabetes register was established in 1998 to monitor diabetes care in the Otago region, New Zealand. Cross-sectional data relating to process and outcome measures were collected annually from participating general practices, 93% of general practitioners in the region. Generalised estimating equations with robust standard errors were used to test for trends in clinical measures across the study period. Results: Process measures improved dramatically over the 6-year period. The proportion of patients prescribed ACE inhibitors and other antihypertensives increased markedly (32.3–52.4% and 13.2–27.1%, respectively) and both mean systolic and diastolic blood pressure decreased significantly (140.6–137.0 mmHg, p < 0.001 and 78.6–77.0 mmHg, p < 0.001, respectively). The proportion prescribed lipid lowering medication more than trebled (12.4–40.0%), while mean lipid levels improved significantly (total cholesterol: 5.94–5.21 mmol/l, p < 0.001, HDL-cholesterol: 1.23–1.28 mmol/l, p < 0.001 and triglycerides: 2.17–1.94 mmol/l, p < 0.001). Mean weight increased significantly, as did HbA1c in all treatment groups except type 2 diabetic patients treated with combined insulin and oral hypoglycaemic agents. Conclusions: At a population level appreciable improvements in blood pressure and lipid control were observed, but not glycaemic control, probably due to insufficient attention to necessary lifestyle changes.