Organisation of primary diabetes care in people with type 2 diabetes in relation to all-cause mortality: A nationwide register-based cohort study

Rebecka Husdal; Eva Thors Adolfsson; Janeth Leksell; Björn Eliasson; Stefan Jansson; Lars Jerdén; Jan Stålhammar; Lars Steen; Thorne Wallman; Ann-Marie Svensson; Andreas Rosenblad

doi:10.1016/j.diabres.2020.108352

Organisation of primary diabetes care in people with type 2 diabetes in relation to all-cause mortality: A nationwide register-based cohort study

Diabetes Res Clin Pract. 2020 Sep:167:108352. doi: 10.1016/j.diabres.2020.108352. Epub 2020 Jul 23.

Authors

Affiliations

¹ Centre for Clinical Research Västmanland, Uppsala University, Västerås, Sweden; Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden. Electronic address: rebecka.husdal@medsci.uu.se.
² Centre for Clinical Research Västmanland, Uppsala University, Västerås, Sweden.
³ Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
⁴ Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden; National Diabetes Register, Centre of Registers, Gothenburg, Sweden.
⁵ School of Medical Sciences, University Health Care Research Centre, Örebro University, Örebro, Sweden.
⁶ School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden.
⁷ Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden.
⁸ Drug and Therapeutics Committee, Sörmland County Council, Eskilstuna, Sweden.
⁹ Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden.
¹⁰ Department of Medical Sciences, Clinical Diabetology and Metabolism, Uppsala University, Uppsala, Sweden; Department of Statistics, Stockholm University, Stockholm, Sweden.

PMID: 32712123
DOI: 10.1016/j.diabres.2020.108352

Abstract

Aims: To examine if personnel resources and organisational features in Swedish primary health-care centres (PHCCs) are associated to all-cause mortality (ACM) in people with type 2 diabetes mellitus (T2DM).

Methods: A total of 187,570 people with T2DM registered in the Swedish National Diabetes Register (NDR) during 2013 were included in this nationwide cohort study. Individual NDR data were linked to data from a questionnaire addressing personnel resources and organisational features for 787 (68%) PHCCs as well as to individual data on socio-economic status and comorbidities. Furthermore, data on ACM were obtained and followed up until 30 January 2018. Hierarchical Cox regression analyses were applied.

Results: After a median follow-up of 4.2 years, 27,136 (14.5%) participants had died. An association was found between number of whole-time-equivalent (WTE) general practitioner's (GP's) devoted to diabetes care/500 people with T2DM and lower risk of early death (hazard ratio 0.919 [95% confidence interval 0.895-0.945] per additional WTE GP; p = 0.002). No other personnel resources or organisational features were significantly associated with ACM.

Conclusions: This nationwide register-based cohort study suggests that the number of WTE GPs devoted to diabetes care have an impact on the risk of early death in people with T2DM.

Keywords: All-cause mortality; Organisation; Primary health care; Type 2 diabetes mellitus.

MeSH terms

Aged
Cohort Studies
Diabetes Mellitus, Type 2 / mortality
Diabetes Mellitus, Type 2 / therapy*
Female
Humans
Longitudinal Studies
Male
Primary Health Care / methods*
Survival Rate