Original article
Vol. 151 No. 2728 (2021)
Representativeness of the Swiss Diabetes Registry – a single centre analysis
- Tobias Eichmüller
- Frida Renström
- Katrin Schimke
- Michael Brändle
Summary
OBJECTIVE
The Swiss Diabetes Registry (SwissDiab) is a multicentre, longitudinal, observational study of outpatients with diabetes receiving treatment at tertiary care centres. The aim of this study was to evaluate the representativeness of the participants at the study centre in the Division of Endocrinology and Diabetes at the Cantonal Hospital of St Gallen by comparing diabetes-related characteristics of participating and nonparticipating patients.
METHODS
The study included 493 SwissDiab participants enrolled between 1 January 2010 and 31 December 2016 and 640 nonparticipating patients treated at the centre during the same time period. For participants and nonparticipating patients, demographic characteristics, clinical findings, blood chemistry and medication were retrieved from the SwissDiab baseline visit and the medical record ±6 months from the first available outpatient visit to the clinic for diabetes-related care within the study period. Nonparticipating patients were further divided into three subgroups: (i) excluded from SwissDiab, or having received (ii) ≥6 months or (iii) <6 months of prior diabetes treatment at the centre. Differences in diabetes-related clinical characteristics were determined using simple bivariate (nonparametric) statistical analyses stratified by diabetes mellitus type 1 and type 2.
RESULTS
Compared with nonparticipants, participants smoked less (diabetes mellitus type 1: 24% vs 45%; diabetes mellitus type 2: 21% vs 29%), had higher educational attainment (diabetes mellitus type 1: 39% vs 21%; and diabetes mellitus type 2: 25% vs 18%) and lower glycated haemoglobin levels (diabetes mellitus type 1: 7.2% vs 7.8%; diabetes mellitus type 2: 7.2% vs 8.1%). In diabetes mellitus type 2, the proportion of females (30% vs 38%) and a migration background (36% vs 49%) were lower among participants. (All p-values <0.05.) In a stratified analysis SwissDiab participants had slightly better controlled diabetes than nonparticipating patients with ≥6 months of prior treatment, whereas the diabetes of patients recently referred to the clinic (with <6 months of prior treatment) and patients excluded from participation in SwissDiab were less well controlled.
CONCLUSION
The observed differences in clinical characteristics between study participants and nonparticipating patients indicate that SwissDiab is likely to overestimate the state of diabetes care and management. The results highlight the need to improve recruitment of females and patients with a migration background in diabetes mellitus type 2.
Clinical trial registration number
NCT01179815
References
- Boeing H, Korfmann A, Bergmann MM. Recruitment procedures of EPIC-Germany. European Investigation into Cancer and Nutrition. Ann Nutr Metab. 1999;43(4):205–15.https://doi.org/10.1159/000012787
- Jousilahti P, Salomaa V, Kuulasmaa K, Niemelä M, Vartiainen E. Total and cause specific mortality among participants and non-participants of population based health surveys: a comprehensive follow up of 54 372 Finnish men and women. J Epidemiol Community Health. 2005;59(4):310–5.https://doi.org/10.1136/jech.2004.024349
- Bopp M, Braun J, Faeh D, Egger M, Spoerri A, Zwahlen M, et al.; Swiss National Cohort Study Group. Variation in mortality patterns among the general population, study participants, and different types of nonparticipants: evidence from 25 years of follow-up. Am J Epidemiol. 2014;180(10):1028–35.https://doi.org/10.1093/aje/kwu226
- Drivsholm T, Eplov LF, Davidsen M, Jørgensen T, Ibsen H, Hollnagel H, et al. Representativeness in population-based studies: a detailed description of non-response in a Danish cohort study. Scand J Public Health. 2006;34(6):623–31.https://doi.org/10.1080/14034940600607616
- American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018;41(Suppl 1):S13–27.https://doi.org/10.2337/dc18-S002
- Davis TM, Zimmet P, Davis WA, Bruce DG, Fida S, Mackay IR. Autoantibodies to glutamic acid decarboxylase in diabetic patients from a multi-ethnic Australian community: the Fremantle Diabetes Study. Diabet Med. 2000;17(9):667–74.https://doi.org/10.1046/j.1464-5491.2000.00359.x
- Liniger C, Albeanu A, Bloise D, Assal JP. The tuning fork revisited. Diabet Med. 1990;7(10):859–64.https://doi.org/10.1111/j.1464-5491.1990.tb01319.x
- Boulton AJ, Armstrong DG, Albert SF, Frykberg RG, Hellman R, Kirkman MS, et al.; American Diabetes Association; American Association of Clinical Endocrinologists. Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care. 2008;31(8):1679–85.https://doi.org/10.2337/dc08-9021
- Nather A, Keng Lin W, Aziz Z, Hj Ong C, Mc Feng B, B Lin C. Assessment of sensory neuropathy in patients with diabetic foot problems. Diabet Foot Ankle. 2011;2:2.
- Schimke KE, Renström F, Meier S, Stettler C, Brändle M ; SwissDiab Study Group. Compliance with guidelines for disease management in diabetes: results from the SwissDiab Registry. BMJ Open Diabetes Res Care. 2018;6(1):e000454.https://doi.org/10.1136/bmjdrc-2017-000454
- Laws RA, St George AB, Rychetnik L, Bauman AE. Diabetes prevention research: a systematic review of external validity in lifestyle interventions. Am J Prev Med. 2012;43(2):205–14.https://doi.org/10.1016/j.amepre.2012.04.017
- David M, Ware R, Donald M, Alati R. Assessing generalisability through the use of disease registers: findings from a diabetes cohort study. BMJ Open. 2011;1(1):e000078.https://doi.org/10.1136/bmjopen-2011-000078
- Holt RI, de Groot M, Golden SH. Diabetes and depression. Curr Diab Rep. 2014;14(6):491.https://doi.org/10.1007/s11892-014-0491-3
- Gerber PA, Spirk D, Brändle M, Thoenes M, Lehmann R, Keller U. Regional differences of glycaemic control in patients with type 2 diabetes mellitus in Switzerland: a national cross-sectional survey. Swiss Med Wkly. 2011;141:w13218.https://doi.org/10.4414/smw.2011.13218
- Sonne-Holm S, Sørensen TI, Jensen G, Schnohr P. Influence of fatness, intelligence, education and sociodemographic factors on response rate in a health survey. J Epidemiol Community Health. 1989;43(4):369–74.https://doi.org/10.1136/jech.43.4.369
- Reinikainen J, Tolonen H, Borodulin K, Härkänen T, Jousilahti P, Karvanen J, et al. Participation rates by educational levels have diverged during 25 years in Finnish health examination surveys. Eur J Public Health. 2018;28(2):237–43.https://doi.org/10.1093/eurpub/ckx151
- Volken T. Second-stage non-response in the Swiss health survey: determinants and bias in outcomes. BMC Public Health. 2013;13(1):167.https://doi.org/10.1186/1471-2458-13-167
- Sedgwick P, Greenwood N. Understanding the Hawthorne effect. BMJ. 2015;351:h4672.https://doi.org/10.1136/bmj.h4672
- Corcillo A, Pivin E, Lalubin F, Pitteloud N, Burnier M, Zanchi A. Glycaemic, blood pressure and lipid goal attainment and chronic kidney disease stage of type 2 diabetic patients treated in primary care practices. Swiss Med Wkly. 2017;147:w14459.
- Zuercher E, Casillas A, Hagon-Traub I, Bordet J, Burnand B, Peytremann-Bridevaux I. Baseline data of a population-based cohort of patients with diabetes in Switzerland (CoDiab-VD). Swiss Med Wkly. 2014;144:w13951.https://doi.org/10.4414/smw.2014.13951