Quality of diabetes care in Austrian diabetic patients willing to participate in a DMP – at baseline

Abstract

Diabetes mellitus type 2 plays an important role in population health worldwide, and diabetes care has been shown to be insufficient. Disease management programmes (DMPs) have been designed to overcome these deficiencies, but data on their effectiveness are inconclusive. One reason for the inconsistent extent of effects may be selection bias. Voluntary programmes might recruit preferably highly motivated patients who are already quite successful in managing diabetes. Other programmes enrol primarily patients with poor metabolic control which may lead to the demonstration of fairly large effects due to regression to the mean. We therefore investigated the baseline characteristics of patients willing to enrol in the Austrian DMP for diabetes mellitus type 2 ("Therapie aktiv"), and their quality of care. We offered the study to all GPs and internists in the province of Salzburg. The physicians were asked to recruit all patients with type 2 diabetes according to WHO/ADA-criteria willing to participate in the Austrian DMP "Therapie aktiv". For all patients, data regarding metabolic control, medication, cardiovascular risk factors and diabetes complications were recorded and then analysed to detect deficiencies in care. One thousand Four hundred and eighty-nine patients (mean age 65.4 ± 10.4 years; 47.8% women) were recruited by 92 physicians. 24.3% of all participants (28.3% of the men and 20.1% of the women) had at least one diabetes-related complication with a significantly higher rate of cardiovascular complications in the male study population. 80.7% of all patients were treated with oral antidiabetics, insulin or both. With regards to quality of care 5% of all patients with an HbA1c above 7.5% did not receive any antidiabetic medication at all. 15.3% of the study population with high blood pressure was not supplied with any antihypertensive medication and 36.6% of the study participants with cardiovascular disease were not treated with a statin. Our results indicate that the majority of the patients receive treatment in adherence to current guidelines. Nevertheless there are deficits in care and hence room for improvement by implementation of the DMP.