Download - SWEDISH NATIONAL DIABETES REGISTER
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SWEDISH NATIONAL DIABETES REGISTER
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The Swedish National Diabetes Register• To improve diabetes care• Started 1996• Internet-based quality registry • Interactive statistical reports• Immediate access real-time results and
comparative national statistics• Local quality control• Benchmarking-public results• Ideally, all diabetic patients should be registered
once every year• >90% of all patients with diabetes
SWEDISH NATIONAL DIABETES REGISTER
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Number of patients registered in NDR
368 577
year 2014
Nationella Diabetesregistret, Registercentrum VGR, Göteborg
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The Swedish National Diabetes Register
Date of registration Microalbuminuria
Caregiver code Diabetic nephropathy
Social security number S-Creatinine
Year of diabetes onset Ischemic heart disease
Type of diabetes Stroke
Diabetes treatment Fundoscopy/retinal photo
HbA1c Visual impairment
Height & weight - BMI Foot examination
Blood pressure Amputation
Antihypertensive treatment Smoking
Blood lipids Waist circumference
Lipid-lowering treatment Physical activity
Aspirin treatment Severe hypoglycaemia
Patient IDClinical characteristics
Risk factor controlTreatments
ComplicationsProcesses
SWEDISH NATIONAL DIABETES REGISTER
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The NDR risk model for 5-year risk of CVD• 58-year old man with DM2• Diabetes duration 5 years• HbA1c 8.0%• BMI 32 kg/m2
• Systolic BP 150 mmHg• Total cholesterol 4.3 mmol/l• HDL cholesterol 1.0 mmol/l• Non-smoker• Macroalbuminuria• No atrial fibrillation• No previous CVD
Gudbjörnsdottir et al. Diabetes Res Clin Pract 2011;93 (2):276-84
An integrated risk model for clinicians
Absolute 5-y risk
Normal' 5-y riskModifiable risk %
SWEDISH NATIONAL DIABETES REGISTER
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Real-time statisticspublicly available
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Real-time statistics publicly available
Time periodIndicator
Patient group Clinic or PC
SWEDISH NATIONAL DIABETES REGISTER
Show results
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Primary care
LDL <2,5 mmol/l in patientswith lipid lowering drugs
Nationella Diabetesregistret, Registercentrum VGR, Göteborg
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Personal Identity Number
PrescribedDrugRegister
NationalPatientRegister
CancerRegister
Causesof Death Register
OtherQualityRegister
EducationRegister(Statistics Sweden)
Medical BirthRegister
SWEDISH NATIONAL DIABETES REGISTER
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Type-1 diabetes – common in young adults
CONCLUSIONS: The incidence of type 1 diabetes in patients aged 34 and younger was two to three times higher than previously reported. The registries can be used to reliably assess incidence rates in this age group.
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The Lancet 2011; 378: 140–6
41-45 years 56-60 years
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Diabetologia 2012;55:2946–53
Incidence rates and 95% CIs for heart failure by updated mean HbA1c category, calculated using a Poisson regression model adjusted for age, sex, updated mean HbA1c and diabetes duration. Men (squares); women (circles); age 61–65 years (white); 71–75 years (black)
Conclusion- Heart failure should be considered a major diabetic complication in type 1 and 2 diabetes- Glycaemic control is an independent risk factor of heart failure in type 1 and type 2 diabetes.- Good glycaemic control could prevent heart failure
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Glycemic Control and ExcessMortality in Type 1 Diabetes
Marcus Lind, M.D., Ph.D., Ann-Marie Svensson, Ph.D., Mikhail Kosiborod, M.D., Soffia Gudbjörnsdottir, M.D., Ph.D., Aldina Pivodic, M.Sc., Hans Wedel, Ph.D., Sofia
Dahlqvist, Mark Clements, M.D., Ph.D., and Annika Rosengren, M.D., Ph.D.
N Engl J MedVolume 371(21):1972-1982
November 20, 2014
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• Registry-based observational study• to determine the excess risk of death according to
the level of glycemic control in Swedish population of persons with type 1 diabetes
• For each patients, five controls were selected from the general population and matched according to age, sex and county.
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Hazard ratio (relative risk) for death (total and CVD) forPersons with typ-1 diabetes compared with controls- by sex and age
Lind M et al. N Engl J Med 2014;371:1972-1982
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Conclusions
Patients with type 1 diabetes and good metabolic control, HbA1c ≤6.9% (52 mmol/mol) – had a risk of death from any cause or from cardiovascular causes that was twice as high as the risk for matched controls.
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Patients with type 1 diabetes have a loss of life expectancyat age 20 years of approximately 12 years, compared with thegeneral population.
Livingstone et al, JAMA, 2015
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What’s new in type 1 diabetes?• it is more common than we thought• HbA1c is strongly related to heart failure• It is associated with increased mortality,
and diminished life-expectancy• There are modifiable risk factors...
HAVE WE IMPROVED PROGNOSISIN TYPE 1 DIABETES?
Nationella Diabetesregistret, Registercentrum VGR, Göteborg
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The Swedish National Diabetes Register
SWEDISH NATIONAL DIABETES REGISTER
• Excellent opportunities for long-term studies of a large (and increasing) patient population; epidemiology, health economics, cancer, cardiology, therapy, social sciences and so on
• > 70 original scientific papers – Good collaborations!•Annika Rosengren
•Marcus Lind
• PROM (Patient Reported Outcome Measurments) -A new area to explore
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Trends in Swedish diabetes care 1996-2014
•Risk factor control is improving
•Much less variation between units
•NDR is an important tool for improvement
•Real-time statistics, publicly available
•Focus on PROM
•Focus on early diagnosisSWEDISH NATIONAL DIABETES REGISTER
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PLoS ONE 6(4): e18744. doi:10.1371/journal.pone.0018744
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Nationella Diabetesregistret, Registercentrum VGR
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Fig. 1 – Hazard ratios (95% CI) for outcomes with categories of BMI and TG:HDL < 1.9 or I1.9, fully adjusted by model 2 (age, sex, smoking, and a history of CVD, diabetes duration, HbA1c, type of hypoglycaemic treatment, systolic BP, LDL cholesterol, cumulative albuminuria), in 54,061 patients with type 2 diabetes aged 30–74 years
Fatal/nonfatal CHD
Nationella Diabetesregistret, Registercentrum VGR
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Main conclusions: Low physical activity -> 25% greater risk of coronary and cardiovascular events than high activity, and 70% greater risk of a fatal CV event.