Identifying targets to improve treatment in type 2 diabetes; the Groningen Initiative to aNalyse Type 2 diabetes Treatment (GIANTT) observational study

Purpose Assessment of quality of cardiometabolic risk management in diabetes in primary care. Methods In a descriptive cohort study including 95 Dutch general practices, we assessed medication treatment in relation to the level of control for HbA1c, systolic blood pressure (SBP) and LDL‐cholesterol (LDL‐c) in 2007. We also applied a prospective measure of treatment quality by assessing treatment modifications in not well‐controlled patients. In a subpopulation of 23 practices, we studied trends in these quality indicators from 2004 (2059 patients) to 2007 (2929 patients). Results In 2007, averages for HbA1c, SBP and LDL‐c were 6.9%, 142 mmHg and 2.3 mmol/l, respectively. Of the patients with an HbA1c > 8.5%, 16% were treated with one oral drug class and 50% used insulin. In 27% of these patients, therapy modification occurred subsequently. During the 4‐year period, a slight decrease in average HbA1c was observed, but no changes in treatment level. In 2007, 56% of the patients had an SBP ≥140 mmHg, 19% of whom were not using antihypertensives. In the 13% with an SBP >160 mmHg, 23% received a therapy modification. During the 4‐year period, the average SBP decreased with 6 mmHg but the treatment level showed no substantial increase. In 2007, 39% had an LDL‐c level ≥2.5 mmol/l, 49% of whom were not using statins. Of the patients with an LDL‐c >3.5 mmol/l, only 9% received a therapy modification. Conclusions The decreasing population averages of HbA1c, SBP and LDL‐c values suggest improvement in quality of care. However, the relatively few therapy modifications observed in insufficiently controlled patients show room for improvement. Copyright © 2010 John Wiley & Sons, Ltd.