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Factors associated with treatment in primary versus specialist care: A population‐based study of people with type 2 and type 1 diabetes
Author(s) -
Slåtsve Kristina B.,
Claudi Tor,
Lappegård Knut T.,
Jenum Anne K.,
Larsen Marthe,
Nøkleby Kjersti,
Cooper John G.,
Sandberg Sverre,
Berg Tore J.
Publication year - 2021
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.14580
Subject(s) - medicine , type 2 diabetes , diabetes mellitus , population , logistic regression , diabetic retinopathy , family medicine , shared care , primary care , environmental health , endocrinology
Abstract Aims The objectives of this study are to identify the proportion and characteristics of people with type 1 and 2 diabetes treated in primary, specialist and shared care and to identify the proportion of persons with type 2 diabetes reaching HbA 1c treatment targets and the clinical risk factors and general practitioner and practice characteristics associated with treatment in specialist care. Methods Population‐based cross‐sectional study including all adults ≥18 years diagnosed with diabetes in primary and specialist care in Salten, Norway. We used multivariable mixed‐effects logistic regression models with level of care as outcome variable and population, general practitioner, and practice characteristics as exposure variables. Results Of 2704 people with type 2 diabetes, 13.5% were treated in shared care and 2.1% in specialist care only. Of 305 people with type 1 diabetes, 14.4% received treatment in primary care only. The HbA 1c treatment target of 53 mmol/mol (7.0%) was reached by 67.3% of people with type 2 diabetes in primary care versus 30.4% in specialist care. HbA 1c , use of insulin, coronary heart disease, retinopathy and urban practice location were positively associated with treatment in specialist care. General practitioners’ use of a structured form and a diabetes nurse were negatively associated with specialist care. Conclusions Of people with type 2 diabetes, 16% were treated in specialist care. They had higher HbA 1c and more vascular complications, as expected from priority guidelines. The use of a structured diabetes form and diabetes nurses seem to support type 2 diabetes follow‐up in primary care.