Quality Of Diabetes Care Research Articles

Dynamic monitoring of HbA1c in Russian regions: data comparison of mobile medical center (Diamodul) and national diabetes register of Russian Federation

BACKGROUND: Glikogemoglobin (HbA1c) is a key clinical marker for evaluating the effectiveness of glucose-lowering therapy for patients with diabetes mellitus (DM) and the quality of diabetic care.
 AIMS: to conduct dynamic monitoring of the quality of glycemic control in DM patients based on a comprehensive examination in mobile medical center (Diamodul) during repeated visits to the regions in 2019 compared with visits of Based Federal program Diabetes Mellitus (20052010) and data of the National diabetes register (NDR).
 MATERIALS AND METHODS: The object of the study: patients with T1DM and T2DM examined in Diamodul in 2019 in Voronezh region (Vr), Krasnodar region (Kr) (n = 600), there were dynamic group of re-examined (Vr n = 224; Kr n = 113), random group of new patients (Vr n = 72; Kr n = 191); group of adult patients from NDR with indicated HbA1c in 2019 (n = 2410067).
 RESULTS: According to Diamodul, the HbA1c levels are significantly worse than they were reported to NDR: the proportion of patients achieved HbA1c 7% for T1DM is 13.3% and 11.7%; T2DM 25.1% and 28.6%, in Kr and Vr, respectively; in NDR: T1DM 37.4%, T2DM 52.2%. The average HbA1c values in the Diamodul are higher than in NDR by 0.95% for T1DM, 1.41% for T2DM patients. The proportion of patients with HbA1c9% decrease in dynamic of examinations through years in T1: in Vr from 53.1% in 2005 and 55.8% in 2010 to 42.9% in 2019, in Kr from 53.2% in 2006 to 43.8% in 2019; also there were decreases in the average HbA1c values in Vr from 9.3% in 2005 and 9.4% in 2010 to 8.8% in 2019; in Kr from 9.1% in 2006 to 8.7% in 2019. In T2DM patients with the best parameters of DM control in a whole, the positive trends were less pronounced and are assessed as non-deterioration: the proportion of HbA1c9 % in Vr: 34.7%34.7%36.4%, in Kr 40.1%28.4%; average values of HbA1c: 8.2%8.4%8.5% and 8.6%8.4%, respectively.
 CONCLUSIONS: The data of the research clearly indicates the need for 100% inclusion of HbA1c in the examination standards in all DM patients at the primary level at least 1 time per year, in order to monitor the real clinical situation, the effectiveness of glucose-lowering therapy and its timely intensification to prevent development of complications.

A performance score of the quality of inpatient diabetes care is a marker of clinical outcomes and suggests a cause-effect relationship between hypoglycaemia and the risk of in-hospital mortality.

To build a tool to assess the management of inpatients with diabetes mellitus and to investigate its relationship, if any, with clinical outcomes. A total of 678 patients from different settings, Internal Medicine (IMU, n = 255), General Surgery (GSU, n = 230) and Intensive Care (ICU, n = 193) Units, were enrolled. A work-flow of clinical care of diabetes was created according to guidelines. The workflow was divided into five different domains: (a) initial assessment; (b) glucose monitoring; (c) medical therapy; (d) consultancies; (e) discharge. Each domain was assessed by a performance score (PS), computed as the sum of the scores achieved in a set of indicators of clinical appropriateness, management and patient empowerment. Appropriate glucose goals were included as intermediate phenotypes. Clinical outcomes included: hypoglycaemia, survival rate and clinical conditions at discharge. The total PS and those of initial assessment and glucose monitoring were significantly lower in GSU with respect to IMU and ICU (P < .0001). The glucose monitoring PS was associated with lower risk of hypoglycaemia (OR = 0.55; P < .0001), whereas both the PSs of glucose monitoring and medical therapy resulted associated with higher in-hospital survival only in the IMU ward (OR = 6.67 P = .001 and OR = 2.38 P = .03, respectively). Instrumental variable analysis with the aid of PS of glucose monitoring showed that hypoglycaemia may play a causal role in in-hospital mortality (P = .04). The quality of in-hospital care of diabetes may affect patient outcomes, including glucose control and the risk of hypoglycaemia, and through the latter it may influence the risk of in-hospital mortality.

1176-P: The Value of Quality Improvement Programs in Diabetes Care: Experience from the Prime Program

The quality of diabetes care is suboptimal worldwide. The Joslin PRIME program assists healthcare professionals (HCPs) with improving diabetes outcomes using scalable quality improvement (QI) methodology. We present findings from a large-scale PRIME implementation focused on A1c reduction. An invitation was sent to 29 HCPs within a large multi-specialty medical group in Springfield, IL. Seventeen HCPs enrolled in the program. Each HCP identified a medical assistant or nurse within the practice to serve as the Diabetes Care Coordinator (DCC) and assist with leading QI activities. Following a live QI workshop, each team (HCP and DCC) learned how to create plan-do-study-act (PDSA) cycles, received a diabetes registry on patients with diabetes and established a plan to decrease the proportion of patients with A1c&amp;gt;9%. Teams were offered online CME, weekly support calls and guidance to implement QI activities using PDSA cycles. De-identified data including clinical metrics on all patients with diabetes, based on ICD-10 codes, cared for by 17 enrolled HCPs (EG) and 12 unenrolled HCPs (UG) were evaluated before and 5 months after institution of the program. Differences in proportion of patients with A1c&amp;gt;9% before the program (P1) and at 5 months (P2) were compared using Chi-square. Twelve participants completed at least one PDSA cycle and saw 39% of their patients with diabetes in 5 months, compared to 21% in the remaining participants. In the EG, P1 was 12% and P2 was 10% (p=0.037). In the UG, P1 was 11% and P2 was 10%, (p=0.136). The odds ratio of having A1c&amp;gt;9% was 0.79 (95% CI 0.63-0.99, p=0.037) in the EG and 0.86 (95% CI 0.71-1.05, p=0.136) in the UG. The proportion of patients with A1c&amp;gt;9% in the EG was significantly lower 5 months after institution of the program. Based on these preliminary data, the PRIME QI program, which is mostly delivered remotely, has the potential to assist HCPs to enhance the quality of diabetes care if applied at a larger scale. Disclosure J. Mitri: Consultant; Spouse/Partner; Janssen Pharmaceuticals, Inc., kymera. Consultant; Self; national dairy council/local dairy council. Research Support; Spouse/Partner; AbbVie Inc., beigene, Janssen Pharmaceuticals, Inc. Research Support; Self; Kowa Pharmaceuticals America, Inc., national dairy council. Research Support; Spouse/Partner; pharma cyclic, TG therapeutics. W. Charlot: None. B.L. Zanger: None. A. Millan-Ferro: None.

1182-P: Strategies and Factors Associated with Top Performance in Primary Care for Diabetes: Insights from Mixed Methods

Background: Diabetes care quality has changed little over the past 12 years. To learn what strategies and factors seem most important for improvement, we conducted a mixed method analysis of clinic interviews and characteristics of clinics that are in the high, middle, and low quartiles on a composite measure for diabetes. Method: We interviewed 31 leaders from 17 primary care clinics selected from the 416 that agreed to participate in a larger observational study of diabetes performance improvement. Semi-structured interviews on barriers and facilitators of diabetes care were recorded, transcribed, and analyzed for both comparison among clinics at different levels of performance on the outcome measure. We combined interview data with quantitative data about clinic performance on a standardized composite measure of diabetes outcomes and a survey of the presence of care management processes. Results: Interview analysis identified 10 themes that provided unique insights into the factors and strategies that were associated with differences in performance level. The main difference among them was the degree to which top performing clinics used patient data to guide proactive and outreach methods to intensify treatment and monitor impact. Top clinics also reported fewer barriers and more facilitators than lower ranked ones, while all recognized key help from the larger organizations of which most were a part. Conclusions: Top performing clinics’ approach to diabetes care differs from lower performing clinics focusing on proactive care occurring outside of the traditional practice setting. Although confirmatory studies are needed for these preliminary findings, clinical leaders might benefit by considering the value of replicating these differences. Disclosure L. Solberg: None. K.A. Peterson: None. H.N. Fu: None. M. Eder: None. R. Jacobsen: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R18DK110732)

1181-P: Glycemic Relapse: Major Threat to Ongoing Improvement in Diabetes Care

Purpose: Adequate glycemic control is a cornerstone of high quality diabetes care. Improvement in glycemic control is the net of two vectors: the number of patients who newly achieve glycemic control (improvement vector), minus the number of patients who relapse from adequate to inadequate glycemic control (relapse vector). The purpose of this analysis s to quantify the improvement and relapse vector in a single large care delivery system.

Managing Diabetes in Hard to Reach Populations: A Review of Telehealth Interventions.

Diabetes mellitus is a leading chronic disease worldwide. Access to diabetes care varies widely and is influenced by multiple factors including social, geographic, and economic conditions. The use of technology to expand healthcare may bridge these barriers and improve access. Our aim was to review the evidence for the role of telehealth to expand access to quality diabetes care. There is evidence that application of technology-based programs to deliver healthcare are both feasible and effective. These programs are accepted by both patients and providers, can reduce healthcare costs, and may redress inequalities in healthcare access. Technology-based care models can improve disease management, enhance efficiency and clinical decision-making, promote patient self-management skills, and promote patient centered care. Future research should focus on implementation of technology-based healthcare delivery programs on a larger scale.

Nationwide Survey on Actual Interventions for Type2 Diabetes by Japanese Practitioners (NSAID Study-1): Glycemic, Weight, and Blood Pressure Management.

IntroductionConsidering the increase in the number of patients with diabetes, the quality of diabetes care provided by general practitioners (GP) is critical for preventing complications. We performed a nationwide survey to determine whether the diabetic management provided to patients with type 2 diabetes mellitus (T2DM) by Japanese practitioners is appropriate.MethodsWe randomly selected 463 clinics throughout Japan; 8070 patients with T2DM (6525 and 1545 under the care of GP and specialists [SP], respectively) were enrolled. We obtained information on hemoglobin A1c (HbA1c) levels, age, height, body weight, diabetes type and treatment modality, blood pressure (BP), and hypertension or dyslipidemia from each patient. Additionally, we surveyed the collaborations among physicians.ResultsThe median HbA1c level of patients treated by GP was lower than that of patients treated by SP (6.8 [6.2–7.3], median [interquartile range] vs. 6.9 [6.5–7.5], p < 0.0001). The percentage of patients receiving insulin therapy was also higher (23.8%) among patients treated by SP than among those treated by GP (8.6%). Patients not receiving insulin therapy showed lower median HbA1c levels than those receiving insulin therapy, irrespective of the care provider. The mean body mass index of patients with HbA1c levels < 6.9% or > 9.0% cared for by SP was lower than that of those cared for by GP. The rate of target BP (< 140/90 mmHg) achievement was 73.2% and 73.3% among patients with T2DM and hypertension cared for by GP and SP, respectively. Furthermore, 88.2% of GP reported that consulting with SP was easy.ConclusionThe present study clearly demonstrated that many patients with T2DM are appropriately cared for by general practitioners instead of diabetes specialists in Japan, although the number of diabetes specialists is insufficient to cover all patients with diabetes.

Comparative evaluation of quality of diabetes care within a population using discrete HbA1c thresholds versus longitudinal trends within a defined time period

BackgroundHbA1c is a quality measurement for a population’s diabetes care. Currently, discrete values are used to judge the care quality. However, an improved trend may have been achieved without reaching...

Transitioning to Value-Based Diabetes Care: A Call for Action Derived from Primary Care Providers in South Florida.

In Florida, 2.4 million people have diabetes and 5.8 million are pre-diabetic. Not only has the prevalence of diabetes doubled over the past 20 years from 5.2 in 1992 to 11.2 in 2014, but the Centers for Disease Control and Prevention expects 1 out of every 3 adults will have diabetes by the year 2050. In addition, in every year since 1996, Florida well exceeds the national levels in terms of prevalence of diabetes, and the gap is getting wider. A study was conducted to gather information from key physician stakeholders as to how to address unmet needs of patients at risk for, or whom already have, diabetes in a tri-county region of South Florida where the prevalence of diabetes is very high. The goal was to catalyze innovation and generate solutions for high quality and affordable diabetes care by convening community physicians in South Florida and querying them about solutions for delivering value-based care. A physician-led task force of community physicians was convened to uncover unmet needs in the diabetes care continuum, identify areas of improvement for coordinating care across the continuum and effectively accessing specialty care. Focus groups were convened with 30 participants to capture qualitative data relative to unmet needs, utilizing the Rapid Ideation Technique. A survey instrument was designed and administered to the twenty-one community clinicians on the task force to augment the qualitative data with quantitative data. The first part of the survey captured characteristics of the participating clinicians, their practices, their diabetes services and management approaches. The second part of the survey captured individual ratings of the importance and merit of needs and/or potential solutions generated. The focus groups generated a wealth of information regarding challenges, issues, areas of opportunities, and potential solutions that could be organized within eight main themes: care coordination and integration; patient engagement, education and behavioral change; physician and practice support; EMR and data issues; telehealth solutions; health informatics and data analytics; and access to care. The surveys culminated in the formation of a Call-For-Action Agenda for immediate work. The ultimate goal of the taskforce was to catalyze innovation and generate solutions for high quality and affordable care. This article reports the findings and provides a roadmap for the future.

Racial and Ethnic Disparities in Diabetes Care Quality among Women of Reproductive Age in an Integrated Delivery System.

Diabetes is increasingly prevalent among women of reproductive age, yet little is known about quality of diabetes care for this population at increased risk of diabetes complications and poor maternal and infant health outcomes. Previous studies have identified racial/ethnic disparities in diabetes care, but patterns among women of reproductive age have not been examined. This retrospective cohort study analyzed 2016 data from Kaiser Permanente Northern California, a large integrated delivery system. Outcomes were quality of diabetes care measures-glycemic testing, glycemic control, and medication adherence-among women ages 18 to 44 with type 1 or type 2 diabetes (N=9,923). Poisson regression was used to estimate the association between patient race/ethnicity and each outcome, adjusting for other patient characteristics and health care use. In this cohort, 83% of participants had type 2 diabetes; 31% and 36% of women with type 2 and type 1 diabetes, respectively, had poor glycemic control (hemoglobin A1c of ≥9%), and approximately one-third of women with type 2 diabetes exhibited nonadherence to diabetes medications. Compared with non-Hispanic White women with type 2 diabetes, non-Hispanic Black women (adjusted risk ratio, 1.2; 95% confidence interval, 1.1-1.3) and Hispanic women (adjusted risk ratio, 1.2; 95% confidence interval, 1.1-1.3) were more likely to have poor control. Findings among women with type 1 diabetes were similar. Our findings indicate opportunities to decrease disparities and improve quality of diabetes care for reproductive-aged women. Elucidating the contributing factors to poor glycemic control and medication adherence in this population, particularly among Black, Hispanic, and Asian women, should be a high research and practice priority.

Prevalence of Diabetic Retinopathy in Type 1 and Type 2 Diabetes Mellitus Patients in North-East Poland.

Background and Objectives: The global epidemic of diabetes, especially type 2 (DM2), is related to lifestyle changes, obesity, and the process of population aging. Diabetic retinopathy (DR) is the most serious complication of the eye caused by diabetes. The aim of this research was to assess the prevalence of diabetic retinopathy in type 1 and type 2 diabetes mellitus patients in north-east Poland. Materials and Methods: The eye fundus was assessed on the basis of two-field 50 degrees color fundus photographs that showed the optic nerve and macula in the center after the pupil was dilated with 1% tropicamide. Results: The experimental group included 315 (26%) patients with type 1 diabetes mellitus (DM1) and 894 (74%) patients with DM2. DM1 patients were diagnosed with DR in 32.58% of cases, with non-proliferative diabetic retinopathy (NPDR) in 24.44% of cases, proliferative diabetic retinopathy (PDR) in 1.59% of cases, diabetic macular edema (DME) in 5.40% of cases, and PDR with DME in 0.95% of cases. DR was found in DM2 patients in 23.04% of cases, NPDR in 17.11% of cases, PDR in 1.01% of cases, DME in 4.81% of cases, and PDR with DME in 0.11% of cases. Conclusions: The presented study is the first Polish study on the prevalence of diabetic retinopathy presenting a large group of patients, and its results could be extrapolated to the whole country. Diabetic retinopathy was found in 25.48% of patients in the whole experimental group. The above results place Poland within the European average, indicating the quality of diabetic care offered in Poland, based on the number of observed complications.

Patients’ perspectives on how to improve diabetes care and self-management: qualitative study

ObjectivePeople living with diabetes need and deserve high-quality, individualised care. However, providing such care remains a challenge in many countries, including Canada. Patients’ expertise, if acknowledged and adequately translated, could...

Diabetic foot care: knowledge and practice

BackgroundDiabetic foot ulcers (DFUs) are common problems in diabetes. One of the most important factors affecting the quality of diabetes care is knowledge and practice. The current study aimed at determining the knowledge and practice of patients with diabetes regarding the prevention and care of DFUs.MethodsThe current analytical, cross sectional study was conducted in Guilan Province (north of Iran) on 375 patients registered in the medical records as type 2 diabetes mellitus. Demographic characteristics, knowledge, and practice of participants were recorded in a questionnaire during face-to-face interviews conducted by the researcher. Descriptive and inferential statistics were performed using SPSS version18.ResultsThe mean score of knowledge was 8.63 ± 2.5 out of 15, indicating that the majority of participants had a poor knowledge (84.8%). The mean practice score was 7.6 ± 2.5 out of 15, indicating that a half of them had poor performance (49.6%). There was a significant and direct correlation between knowledge and practice. Knowledge level, place of residence, marital status, and history of admission due to diabetic foot were predictors of practice score.ConclusionsAccording to the low level of knowledge and practice in patients with diabetes regarding the prevention and care of DFUs, and considering the significant relationship of some demographics of patients with knowledge and practice scores, a targeted educational program is needed to promote knowledge of patients with diabetes.

Statin prescription among patients with type 2 diabetes in Botswana: findings and implications

BackgroundThere is evidence of statin benefit among patients with diabetes regardless of cholesterol levels or prior cardiovascular disease history. Despite the evidence, there is under-prescription of statins in clinical practice. This study aimed to assess statin prescriptions and associated factors among patients with type 2 diabetes in Botswana.MethodsThe study was a secondary data analysis of 500 randomly selected type 2 diabetes patients at a specialised diabetes clinic at Gaborone, Botswana. We assessed the proportion of statin-eligible patients who are prescribed statins and evaluated the adjusted associations between various factors and statin prescriptions.ResultsOverall, 477 (95.4%) participants were eligible for a statin prescription. Clinicians prescribed statins in 217 (45.5%) of eligible participants, and only one (4.4%) ineligible participant. The probability of a statin prescription was higher in participants with high baseline low-density lipoprotein cholesterol (risk ratio [RR]: 1.49; 95%CI: 1.17–1.89), increasing duration of diabetes (RR: 1.01; 95%CI 1.00–1.03) and the presence of chronic kidney disease (RR: 1.35; 95%CI: 1.06–1.74).ConclusionA large proportion with type 2 diabetes in Gaborone is not receiving statins. Clinicians did not consider most guideline-recommended indications for statin prescriptions. The findings call for improvement in diabetes quality of care by implementing evidence-based guideline recommendations.

Impact evaluation of the Steno REACH Certificate Course in Clinical Diabetes Care for health care providers in Malaysia: protocol for a quasi-experimental, mixed-methods research study

The burden of diabetes continues to increase in Malaysia, and the public primary health sector has an insufficient number of health care providers well-trained in diabetes care. The Ministry of Health Malaysia collaborated with Steno Diabetes Center to educate primary care doctors and nurses on the fundamentals of clinical diabetes care using a competency-based approach that blends e-learning, classroom-based learning, and clinic-based group work. This programme is called Steno REACH Certificate Course in Clinical Diabetes Care (SRCC). The aim of this study was to assess the effectiveness of the SRCC intervention in improving diabetes-related knowledge, attitudes, skills and clinical practices among non-specialised doctors and general nurses working in public health clinics in Malaysia. This paper presents the study protocol. A quasi-experimental, mixed-methods study based on Solomon’s Four Group Design was applied. Non-specialist doctors and general nurses from ten health clinics were randomly selected to receive the educational intervention. Comparison clinics were purposive selected matching on proxy indicators for quality of diabetes care. The intervention consisted of 50 hours of e-learning, 48 hours of classroom-based learning and approximately 25 hours of work-based learning that covered all main aspects of clinical diabetes care and delivered over a six-month period. Primary outcomes were changes in diabetes-related knowledge, attitudes, skills, and clinical practice. Patients’ perceptions regarding the quality of care provided were classified as a secondary outcome. Other outcome measures included patients' assessment of their chronic disease care and providers' perceptions, attitudes and perceived barriers in care delivery. Results from this study will inform future educational approaches within the Malaysian health system. The study is unique because it evaluated a pertinent public health topic using a very robust methodology.

Process, quality and challenges of diabetes care in primary care: a study of district health network in Thailand.

This study aimed to describe the process of care, assess the quality of care based on defined indicators, and identify challenges associated with providing diabetes care via sub-district health promotion hospital (SHPH) facilities in Thailand. Primary care policy has directed that diabetes care be delivered via SHPH in order to reduce hospital congestion and minimize travel costs for patients. Limited data is available regarding the structure for providing care. Likewise, barriers to delivery of optimal care have not been well defined, especially from the perspective of health care providers. This study employed mixed-methods research, which included semi-structured interviews to gain insights into the current diabetes care process, a descriptive study to evaluate quality of care, and use of a focus group to identify challenges associated with delivery of diabetic care via SHPH. Diabetes care processes in primary care included multiple steps and involved collaboration between various health care providers at both the hospital and SHPH. Four process indicators and one outcome had been achieved but performance of other indicators was apparently low. Three factors were found to pose challenges to providing this service: the resources of the health service, the delivery of services, and patient factors. SHPH require additional support, particularly in the areas of primary care workforce, finance, medical device procurement, and patient information systems. While delivery of diabetes care via primary care centers has been well established in Thailand, regional differences in the quality of care persist. Additional support is required to strengthen the primary care system nationwide.

Knowledge, attitude, and practice regarding diabetic dermopathy among physicians in Riyadh, Saudi Arabia.

Context:Type 2 diabetes mellitus (T2DM) is expanding at an epidemic rate. Diabetes and the prediabetes are associated with a number of skin manifestations which are seen in a minimum of 30% of diabetics as first sign or during the course of their illness. To the best of our knowledge, this is the first study in Saudi Arabia that assess physicians’ knowledge, attitude and practice regarding this common problem.Aims:To assess the level of knowledge, attitude, and practice (KAP) about diabetic dermopathy among a representative sample of physicians in Saudi Arabia; and to identify determinants of good KAP.Settings and Design:A cross-sectional study was conducted among physicians at university and governmental hospitals in Riyadh, KSAMaterials and Methods:112 physicians from different specialties and experiences were interviewed using an English self-administered questionnaire.Statistical analysis used:Data was analyzed using IBM SPSS Statistics for Windows, version 20, with appropriate statistical test. P value < 0.05 was considered significant.Results:It included 112 physicians in which 43.8%, Family medicine, 31.3% endocrinologist/Internal Medicine, and 25.0% GPs/Interns. Physicians above 35 year-old, master/PhD holders, consultants, endocrinologist/Internal Medicine, and those in practice for more than 10 years scored the highest in the overall knowledge. However, only 47% were confident to diagnose diabetic dermopathy. Moreover, majority of physicians regardless of the specialty, had educated their patients, examined them for other lesions, and followed conservative protocols. As much as 74.3% of endocrinologists seek for dermatologists’ consultation.Conclusions:Physicians’ knowledge regarding diabetic dermopathy is suboptimal, this may impact quality of diabetes care.

Audit of diabetic care in family practice center in Abha City, Aseer region: CBAHI standards application.

Objective:The objectives of this study is to assess the quality of diabetic care at AlManhal PHCC based on CBAHI standards.Methods:This audit was conducted during 2018 at Al_Manhal PHCC through assessment all aspects of DM care ( structures, processes and outcomes) using CBAHI standards . Data entry and analysis were managed used SPSS.Results:Most of DM structures were available at the PHCC , however, health educational program , lab relevant facilities were partially met the standards. Records of 429 patients were assessed for process of care which were satisfactory except for laboratory investigations and eye examination which were partially met . Good DM metabolic control was (28%) , HTN control (71%) and lipid control( 54%), good compliance with appointment was 85% . The most common documented complications were retinopathy( 14%), nephropathy (4.5%) and CHD( 4%).Conclusion and Recommendations:This audit revealed that using of CBAHI standards for DM care at PHCC is simple and practical and could help to identify the weak areas that needs improvement. The present care of DM in our PHCC has acceptable infrastructures except for health education program , laboratory and referral system which should be scaled up to improve the processes and outcomes. DM control is still a big challenge and needs more collaborative effort between health care providers and patients.

Providing care for children with type 1 diabetes in kindergartens and schools.

Type 1 diabetes in the paediatric population is becoming aserious social problem affecting an increasing number of families with small, dependent children. Polish educational institutions are not prepared to provide care for students with diabetes. There are no nurses who, by law, are responsible for taking care for diabetic children. Teachers are not trained to provide care for pupils with diabetes and there is no system of obligatory, standardized training in this field. The aim of the study was to examine parents' opinions of the quality of care for diabetic students in educational institutions and compare the results obtained in 2013 and 2020. The research, in the form of aquestionnaire containing closed and open questions, was conducted in 2013 (n=602) and 2020 (n=604). There has been aslight positive change in providing the right care for children with type 1 diabetes in school facilities. In 2013 parents rated the quality of diabetic care as: bad - 13%, insufficient - 68%, sufficient - 14%, good - 5%, and in 2020 as: bad - 11%, insufficient - 54%, sufficient - 25.5%, good - 10.5%. However, the problem of the lack of appropriate legal regulations and absence of nurses in educational institutions has deepened. Systematic training of staff financed from public funds has still not been provided. It is necessary to solve the problem systematically, introduce mandatory, standardized training, clarify the responsibilities of teachers taking care of children with diabetes, introduce appropriate legislative changes and regulate the currently omitted preschool children.

Prevalence, incidence, mortality, and quality of care of diagnosed diabetes in Greenland

AimsTo estimate prevalence, incidence, and mortality of diagnosed diabetes in Greenland, and to evaluate quality of diabetes care among men and women, and patients living in towns and settlements. MethodsThis study was designed as an observational cross-sectional study based on review of data obtained from the electronic medical record (EMR) in Greenland. All permanent residents of Greenland registered with a diabetes diagnosis in the EMR (N = 1498) were included. ResultsThe age-standardized prevalence of diabetes was 2.19% as of Nov 30, 2018. The age-standardized incidence was 147 per 100,000 per year and the age-standardized mortality was 62 per 10,000 person-year among people aged ≥0 years old (Dec 1, 2017 to Nov 30, 2018). Quality of diabetes care was slightly higher among women compared to men concerning proportion with annual measurement of glycated haemoglobin (HbA1c) (89.9% vs. 85.8%; p < 0.015), blood pressure (83.7% vs. 76.7%; p < 0.001).The only difference observed in quality of care among settlements and towns was lower proportion tested for microalbuminuria within one year in settlements (50.3% vs. 40.1%; p < 0.001). ConclusionsThe age-standardized prevalence of diagnosed diabetes in Greenland was 2.19% and the prevalence of diagnosed diabetes among adults aged ≥20 years was 3.7%. Only minor differences in quality of care related to gender and place of residence were observed. Further improvements in quality of care are warranted.