1. 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

2. Skaraborg Gothenburg

3. Research use of diabetes registries Specific study question Representative samples Valid methods

4. Research use of diabetes registries focusing on Quality Indicators Patientrelated factors Doctors and nurses Current guidelines Health care organisation / management

5. Research use of diabetes registries Identification of cohorts Patient related factors Hypertension GUIDANCE

6. Skaraborg Primary Care Serving a population of 260 000 inhabitants 15 municipalities 24 health care clinics (3 hospitals) 135 family physicians

7. Skaraborg Primary Care regular follow-up of about… 30 000 patients with hypertension 10 000 patients with diabetes 3000 patients with heart failure

8. 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

9. DM in The Skaraborg SPCD AgegroupAll (n)Number with DMDM / 1000 inh 0-1441672491.2 15-2432307541.7 25-34270571345.0 35-443322337411.3 45-543334799930.0 55-6435087230165.6 65-74238972706113.2 75-84181242690148.4 85+76931084140.9 All2524071039141.2

10. Blood pressure <140/90 mm Hg Agegroupn with BPn with BP <140/90Proportion (%) with BP <140/90 0-1466100 15-24181689 25-341069085 35-4432522168 45-5494552856 55-64220495243 65-74264093435 75-84261484532 85+103035635 All9888394840

11. BMI ≥30 kg/m 2 Agegroupn with a BMIn with BMI ≥30 kg/m 2 Proportion (%) with BMI ≥30 kg/m 2 0-1410 15-247229 25-34853946 35-4427516058 45-5479643755 55-64189290448 65-74225095743 75-84206864231 85+65513320 All8029327441

12. Identification of cohorts Longitudinal follow-up using different health data registries

13. Identification of cohorts longitudinal 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

14. Research use of diabetes registries focusing on Quality Indicators Patientrelated factors Doctors and nurses Current guidelines Health care organisation / management

15. Patient related factors Physical activity (self-reported) Smoking

16. 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)

17. Hypertension in type 2 diabetes EUBIROD - 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

18. Hypertension in type 2 diabetes EUBIROD - limitations Selection bias – different contexts and settings in different regions Standardisation of variables: Validity of ”type of diabetes” must be improved

19. Hypertension in type 2 diabetes EUBIROD - 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

20. GUIDANCE Initiated by EASD 8 countries each collecting 1000 patients Cross-sectional survey of quality indicators vs patient related factors, staff factors Health care organisation GUIDLINES

21. 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.

22. Thank you!

23. Examples from the litterature

24. ”Rule of halves”