The Skaraborg Project

Population based studies over three decades

Professor Ulf Lindblad MD, PhD University of Gothenburg and

West Sweden Primary Care

Mikael Åberg MPH Skaraborg Primary Care R&D

Skaraborg

Gothenburg

Research use of diabetes registries

• Specific study question

• Representative samples

• Valid methods

Research use of diabetes registries focusing on Quality Indicators

• Patientrelated factors

• Doctors and nurses

• Current guidelines

• Health care organisation / management

Research use of diabetes registries

• Identification of cohorts

• Patient related factors

• Hypertension

• GUIDANCE

Skaraborg Primary Care

• Serving a population of 260 000 inhabitants

• 15 municipalities

• 24 health care clinics (3 hospitals)

• 135 family physicians

Skaraborg Primary Careregular follow-up of about…

• 30 000 patients with hypertension

• 10 000 patients with diabetes

• 3000 patients with heart failure

Skaraborg is a regional sample

• Good information on the background population

• Fairly complete data in primary care data registry

• It should be possible to contribute with most relevant indicatiors

DM in The Skaraborg SPCD

Agegroup All (n) Number with DM DM / 1000 inh

0-14 41672 49 1.2

15-24 32307 54 1.7

25-34 27057 134 5.0

35-44 33223 374 11.3

45-54 33347 999 30.0

55-64 35087 2301 65.6

65-74 23897 2706 113.2

75-84 18124 2690 148.4

85+ 7693 1084 140.9

All 252407 10391 41.2

Blood pressure <140/90 mm HgAgegroup n with BP n with BP <140/90 Proportion (%)

with BP <140/90

0-14 6 6 100

15-24 18 16 89

25-34 106 90 85

35-44 325 221 68

45-54 945 528 56

55-64 2204 952 43

65-74 2640 934 35

75-84 2614 845 32

85+ 1030 356 35

All 9888 3948 40

BMI ≥30 kg/m2

Agegroup n with a BMI n with BMI ≥30 kg/m2

Proportion (%) with BMI ≥30 kg/m2

0-14 1 0

15-24 7 2 29

25-34 85 39 46

35-44 275 160 58

45-54 796 437 55

55-64 1892 904 48

65-74 2250 957 43

75-84 2068 642 31

85+ 655 133 20

All 8029 3274 41

Identification of cohorts

• Longitudinal follow-up using different health data registries

Identification of cohortslongitudinal follow-up

• SPCD 2010: All patients seen with diabetes are identified as a cohort

• Linkage to: National Mortality Register National hospital in-patient register National prescription register Tax authorities for income, work and edu

• Ethical board has to approve this

Research use of diabetes registries focusing on Quality Indicators

• Patientrelated factors

• Doctors and nurses

• Current guidelines

• Health care organisation / management

Patient related factors

• Physical activity (self-reported)

• Smoking

Patient related factos and QI’s in diabetes – SPCD Sweden 2008

• Significant association between low physical activity and - higher BMI (p<0.001)- Poorer HbA1c (p<0.001)- Lower HDL (p=0.011 m and p=0.014 w)

• In females smoking was associated with higher BMI (p=0.027) and higher LDL (0.046)

Hypertension in type 2 diabetesEUBIROD - opportunities

• Review hypertension control in diabetes over EU using the same tool to collect data

• Compare contexts and settings for delivery of diabetes care

• Epidemiological tool to survey changes in QI’s over time using a standard method

• Feedback to the clinics for quality assurance

Hypertension in type 2 diabetesEUBIROD - limitations

• Selection bias – different contexts and settings in different regions

• Standardisation of variables: Validity of ”type of diabetes” must be improved

Hypertension in type 2 diabetesEUBIROD - possibilities

• Patient related factors: lifestyles, comorbidity• Factors linked to the health care providers

-organization -staff

• Variation according to local therapeutic guide-lines • Define a cohort to follow longitudinally for

complications

GUIDANCE Initiated by EASD

• 8 countries each collecting 1000 patients• Cross-sectional survey of quality indicators

vs patient related factors, staff factors Health care organisationGUIDLINES

GUIDANCE

Stone MA, Wilkinson JC, Charpentier G, Clochard N, Lindblad U, Müller UA, Nolan J, Rutten GE, Trento M, Kamlesh Khunti K, on behalf of the GUIDANCE Study Group.

Recommendations for the management of people with type 2 diabetes: evaluation and comparison of guidelines from eight European countries.

Diabetes Research and Clinical Practice 2010;87:252-60. Epub 2009 Nov 22.

Thank you!

Examples from the litterature

• Examples from the litterature

”Rule of halves”