Regional differences of glycaemic control in patients with type 2 diabetes mellitus in Switzerland: a national cross-sectional survey
AIMS: We investigated contemporary diabetes care, quality of glycaemic control, and progression of obesity in patients with diabetes mellitus in different cultural regions within Switzerland.
METHODS: Overall, 1121 patients treated for type 2 diabetes mellitus by 134 general practitioners were enrolled in this representative, national, cross-sectional survey and were followed retrospectively from the start of diabetes treatment. Patients were classified into four cultural regions; the German, French, Italian and Romansh speaking parts of Switzerland.
RESULTS: During 5.5 ± 5.1 years of diabetes treatment (retrospective survey), mean HbA1c decreased from 8.28 ± 2.01% to 7.03 ± 1.24%, fasting glucose decreased from 9.97 ± 3.86 to 7.52 ± 2.23 mmol/l, and BMI decreased from 30.2 ± 5.5 to 29.8 ± 5.6 kg/m2 (p <0.001 for all parameters). Insulin therapy was associated with a larger improvement of mean HbA1c (–1.66 ± 2.33% vs. –1.15 ± 1.91%, p = 0.001) and an increase in BMI (+0.36 ± 2.92 vs. –0.63 ± 2.60 kg/m2, p <0.001). At the time when the cross-sectional survey was conducted, the mean HbA1c and fasting glucose were higher in the Italian part compared to other regions (7.72 ± 1.60% and 9.03 ± 2.49 mmol/l, respectively, p <0.001), and lower in the German part (6.89 ± 1.02% and 7.25 ± 2.02 mmol/l, respectively, p <0.001). In comparison to other regions, biguanides were more often used in the French part (86.1% versus 75.7%), insulin secretagogues in the Italian part (69.9% versus 37.8%), thiazolidinedions in the Romansh part (34.1% versus 17.8%), and insulin was more often used in the German part of Switzerland (27.0% versus 17.1%) (p <0.01 for all parameters).
CONCLUSIONS: Efforts to identify regional-cultural differences and attempts to overcome associated potential barriers should be emphasised in any health care system when aiming for better diabetic patient care.
- Khaw KT, Wareham N, Bingham S, Luben R, Welch A, Day N. Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Ann Intern Med. 2004;141(6):413–20.
- Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998;352(9131):837–53.
- Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359(15):1577–89.
- Patel A, MacMahon S, Chalmers J, Neal B, Billot L, Woodward M, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560–72.
- Turnbull FM, Abraira C, Anderson RJ, Byington RP, Chalmers JP, Duckworth WC, et al. Intensive glucose control and macrovascular outcomes in type 2 diabetes. Diabetologia. 2009 Aug 5.
- Standards of medical care in diabetes – 2009. Diabetes care. 2009;32(Suppl 1):S13–61.
- Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, et al. Medical management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia. 2009;52(1):17–30.
- Alvarez Guisasola F, Mavros P, Nocea G, Alemao E, Alexander CM, Yin D. Glycaemic control among patients with type 2 diabetes mellitus in seven European countries: findings from the Real-Life Effectiveness and Care Patterns of Diabetes Management (RECAP-DM) study. Diabetes, obesity & metabolism. 2008;10(Suppl 1):8–15.
- Hoerger TJ, Segel JE, Gregg EW, Saaddine JB. Is glycemic control improving in U.S. adults? Diabetes care. 2008;31(1):81–6.
- Liebl A, Mata M, Eschwege E. Evaluation of risk factors for development of complications in Type II diabetes in Europe. Diabetologia. 2002;45(7):S23–8.
- Melander A, Folino-Gallo P, Walley T, Schwabe U, Groop PH, Klaukka T, et al. Utilisation of antihyperglycaemic drugs in ten European countries: different developments and different levels. Diabetologia. 2006;49(9):2024–9.
- Philippe J, Brändle M, Carrel J, Diem P, Keller U, Kuntschen F, et al. Massnahmen zur Blutzuckerkontrolle bei Patienten mit Typ-2-Diabetes-mellitus. Schweiz Med Forum. 2009;9(3):50–5.
- Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18(6):499–502.
- Allemann S, Saner C, Zwahlen M, Christ ER, Diem P, Stettler C. Long-term cardiovascular and non-cardiovascular mortality in women and men with type 1 and type 2 diabetes mellitus: a 30-year follow-up in Switzerland. Swiss Med Wkly. 2009;139(39-40):576–83.
- Brandle M, Goodall G, Erny-Albrecht KM, Erdmann E, Valentine WJ. Cost-effectiveness of pioglitazone in patients with type 2 diabetes and a history of macrovascular disease in a Swiss setting. Swiss Med Wkly. 2009;139(11–12):173–84.
- Rumawas ME, Meigs JB, Dwyer JT, McKeown NM, Jacques PF. Mediterranean-style dietary pattern, reduced risk of metabolic syndrome traits, and incidence in the Framingham Offspring Cohort. Am J Clin Nutr. 2009;90(6):1608–14.
- Eichholzer M, Bovey F, Jordan P, Probst-Hensch N, Stoffel-Kurt N. Data on overweight and nutrition in the 2007 Swiss Health Survey. Praxis. 2010;99(1):17–25.