Quality of care of patients with type 1 diabetes: Population-based results in a French region

• Published in: Diabetes & metabolism 2012-11, Vol.38 (5), p.436-443
• Main Authors: Penfornis, A, Personeni, E, Tiv, M, Monnier, C, Meillet, L, Combes, J, Mouret, C, Picard, S
• Format: Article
• Language: English
• Subjects: Adult; Age of Onset; Albuminuria - metabolism; Audit; Biological and medical sciences; Blood Glucose Self-Monitoring; Complications; Creatinine - metabolism; Diabetes Complications - drug therapy; Diabetes Complications - epidemiology; Diabetes Complications - metabolism; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 1 - epidemiology; Diabetes Mellitus, Type 1 - metabolism; Diabetes. Impaired glucose tolerance; Diabète de type 1; Endocrine pancreas. Apud cells (diseases); Endocrinology & Metabolism; Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; France; France - epidemiology; General practitioner; Glycated Hemoglobin A - metabolism; Health Surveys; Humans; Hypoglycemic Agents - therapeutic use; Insulin - therapeutic use; Internal Medicine; Male; Medical sciences; Médecin généraliste; Quality of care; Quality of Health Care; Qualité des soins; Retrospective Studies; Specialist; Spécialiste; Survey; Surveys and Questionnaires; Type 1 diabetes
• ISSN: 1262-3636; 1878-1780
• DOI: 10.1016/j.diabet.2012.04.006

Abstract Aim Although the incidence of type 1 diabetes (T1D) has been increasing, little is known of its quality of care. Thus, our survey was designed to retrospectively evaluate this issue in French patients. Methods Patients with T1D living in northeastern France were identified thanks to the healthcare system (CPAM) database, and the resulting list reviewed by local diabetes specialists. All of the listed patients and their primary physicians were asked to fill in a questionnaire including clinical data, laboratory results and follow-up habits. The ‘optimized results’ included CPAM-based results plus any specialized care provided during hospitalizations in diabetes and non-diabetes units, according to questionnaire data. Results A total of 227 individuals, for whom CPAM data were available, were identified as having T1D. From these patients, 174 questionnaires were answered, and optimized results (having both CPAM data and a completely filled-in questionnaire) were available for 149 patients. Of the 169 patients who responded, 71.3% reported at least a yearly visit with a diabetologist. This number reached 77.9% when optimized results were considered. Patients who received specialized care were younger, underwent HbA1c tests more often and were more frequently on optimal treatment; however, there was no difference in HbA1c values or in the prevalence of complications. Eye examinations and kidney tests had been performed at least once over the 2-year period in more than 87% of the patients, whereas around 30%, 21% and 23% had an eye exam, creatinine test and urinary albumin excretion measurement, respectively, only once over the same time period. Conclusion This is the first large-scale study of the quality of care in patients with T1DM in France, and it could serve as a preliminary survey for a national study. Although the follow-up was better than previously reported, there is still considerable room for improvement.