Effects on HbA1c of referral of type 2 diabetes patients to secondary care
Aim To study trajectories of HbA1c in type 2 diabetes (T2D) patients referred to diabetes outpatient clinics (DOCs), and to explore characteristics of referrals and patient pathways in patients treated in DOCs.Methods We retrospectively followed T2D patients from the Norwegian population-based ROSA...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Taylor & Francis Group
2025-04-01
|
| Series: | Scandinavian Journal of Primary Health Care |
| Subjects: | |
| Online Access: | https://www.tandfonline.com/doi/10.1080/02813432.2024.2433107 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849328112348692480 |
|---|---|
| author | Kjersti Nøkleby Anne K. Jenum Esben Selmer Buhl Tor Claudi John G. Cooper Signe Flottorp Karianne F. Løvaas Sverre Sandberg Tore Julsrud Berg |
| author_facet | Kjersti Nøkleby Anne K. Jenum Esben Selmer Buhl Tor Claudi John G. Cooper Signe Flottorp Karianne F. Løvaas Sverre Sandberg Tore Julsrud Berg |
| author_sort | Kjersti Nøkleby |
| collection | DOAJ |
| description | Aim To study trajectories of HbA1c in type 2 diabetes (T2D) patients referred to diabetes outpatient clinics (DOCs), and to explore characteristics of referrals and patient pathways in patients treated in DOCs.Methods We retrospectively followed T2D patients from the Norwegian population-based ROSA 4 study to identify persons with T2D who were referred to a DOC. We used latent class trajectory modelling to identify subgroups of patients with similar patterns of HbA1c one year before to one year after the first consultation at a DOC. We performed multinomial regression analyses to identify baseline characteristics associated with group membership.Results Four hundred and two of 6716 T2D patients started treatment at a DOC, constituting a yearly starting rate of 1.5%. We identified three classes of HbA1c trajectories: (1) stable moderate hyperglycaemia (75%); (2) severe hyperglycaemia with a decline in HbA1c around referral (14%) and (3) severe hyperglycaemia with a decline in HbA1c after starting treatment at the DOC (11%). HbA1c trajectories were associated with diabetes duration RRR 0.92, CI (0.87, 0.97) in class 2 vs. 1 and 0.93 (0.88, 0.98) in class 3 vs. 1. Some differences were found between clinics in rejection rate, processes of care, and duration of follow-up.Conclusions Norwegian GPs handle most T2D patients themselves. Those with T2D and severe hyperglycaemia had a considerable benefit from being referred to a DOC, though with two separate trajectories: One where HbA1c improved around the time of referral, and another that improved after starting in a DOC. |
| format | Article |
| id | doaj-art-7fd002ba9faf45a3a27697e8cfefb577 |
| institution | Kabale University |
| issn | 0281-3432 1502-7724 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Scandinavian Journal of Primary Health Care |
| spelling | doaj-art-7fd002ba9faf45a3a27697e8cfefb5772025-08-20T03:47:40ZengTaylor & Francis GroupScandinavian Journal of Primary Health Care0281-34321502-77242025-04-0143231332310.1080/02813432.2024.2433107Effects on HbA1c of referral of type 2 diabetes patients to secondary careKjersti Nøkleby0Anne K. Jenum1Esben Selmer Buhl2Tor Claudi3John G. Cooper4Signe Flottorp5Karianne F. Løvaas6Sverre Sandberg7Tore Julsrud Berg8Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, NorwayDepartment of General Practice, Institute of Health and Society, General Practice Research Unit (AFE), University of Oslo, Oslo, NorwayDepartment of General Practice, Institute of Health and Society, University of Oslo, Oslo, NorwayDepartment of Medicine, Nordland Hospital, Bodø, NorwayNorwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, NorwayDepartment of General Practice, Institute of Health and Society, University of Oslo, Oslo, NorwayNorwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, NorwayNorwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, NorwayInstitute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, NorwayAim To study trajectories of HbA1c in type 2 diabetes (T2D) patients referred to diabetes outpatient clinics (DOCs), and to explore characteristics of referrals and patient pathways in patients treated in DOCs.Methods We retrospectively followed T2D patients from the Norwegian population-based ROSA 4 study to identify persons with T2D who were referred to a DOC. We used latent class trajectory modelling to identify subgroups of patients with similar patterns of HbA1c one year before to one year after the first consultation at a DOC. We performed multinomial regression analyses to identify baseline characteristics associated with group membership.Results Four hundred and two of 6716 T2D patients started treatment at a DOC, constituting a yearly starting rate of 1.5%. We identified three classes of HbA1c trajectories: (1) stable moderate hyperglycaemia (75%); (2) severe hyperglycaemia with a decline in HbA1c around referral (14%) and (3) severe hyperglycaemia with a decline in HbA1c after starting treatment at the DOC (11%). HbA1c trajectories were associated with diabetes duration RRR 0.92, CI (0.87, 0.97) in class 2 vs. 1 and 0.93 (0.88, 0.98) in class 3 vs. 1. Some differences were found between clinics in rejection rate, processes of care, and duration of follow-up.Conclusions Norwegian GPs handle most T2D patients themselves. Those with T2D and severe hyperglycaemia had a considerable benefit from being referred to a DOC, though with two separate trajectories: One where HbA1c improved around the time of referral, and another that improved after starting in a DOC.https://www.tandfonline.com/doi/10.1080/02813432.2024.2433107Diabetes mellitus, type 2referral and consultationsecondary care centresglycated haemoglobingeneral practice |
| spellingShingle | Kjersti Nøkleby Anne K. Jenum Esben Selmer Buhl Tor Claudi John G. Cooper Signe Flottorp Karianne F. Løvaas Sverre Sandberg Tore Julsrud Berg Effects on HbA1c of referral of type 2 diabetes patients to secondary care Scandinavian Journal of Primary Health Care Diabetes mellitus, type 2 referral and consultation secondary care centres glycated haemoglobin general practice |
| title | Effects on HbA1c of referral of type 2 diabetes patients to secondary care |
| title_full | Effects on HbA1c of referral of type 2 diabetes patients to secondary care |
| title_fullStr | Effects on HbA1c of referral of type 2 diabetes patients to secondary care |
| title_full_unstemmed | Effects on HbA1c of referral of type 2 diabetes patients to secondary care |
| title_short | Effects on HbA1c of referral of type 2 diabetes patients to secondary care |
| title_sort | effects on hba1c of referral of type 2 diabetes patients to secondary care |
| topic | Diabetes mellitus, type 2 referral and consultation secondary care centres glycated haemoglobin general practice |
| url | https://www.tandfonline.com/doi/10.1080/02813432.2024.2433107 |
| work_keys_str_mv | AT kjerstinøkleby effectsonhba1cofreferraloftype2diabetespatientstosecondarycare AT annekjenum effectsonhba1cofreferraloftype2diabetespatientstosecondarycare AT esbenselmerbuhl effectsonhba1cofreferraloftype2diabetespatientstosecondarycare AT torclaudi effectsonhba1cofreferraloftype2diabetespatientstosecondarycare AT johngcooper effectsonhba1cofreferraloftype2diabetespatientstosecondarycare AT signeflottorp effectsonhba1cofreferraloftype2diabetespatientstosecondarycare AT kariannefløvaas effectsonhba1cofreferraloftype2diabetespatientstosecondarycare AT sverresandberg effectsonhba1cofreferraloftype2diabetespatientstosecondarycare AT torejulsrudberg effectsonhba1cofreferraloftype2diabetespatientstosecondarycare |