Contacting dropouts from type 2 diabetes care in public primary health care: description of the patient population

Abstract

Objective: To characterize dropouts from type-2 diabetes (T2D) care in communal primary health care.

Design: An observational study.

Setting: In a Finnish city, patients with T2D who had not contacted the public primary health care system during the past 12 months were identified with a computer based search and contacted by a trained diabetes nurse.

Subjects: Dropouts from T2D treatment.

Main outcome measures: Demographic factors, laboratory parameters, examinations, medications, and comorbidities.

Results: Of the patients with T2D, 10% (n = 356) were dropouts and 60% of them were men. Median HbA_1c was 6.5 (QR for 25% and 75%: 6.0, 7.7) %, (45 [42,61] mmol/mol). Of the dropouts, 14% had HbA_1c ≥ 9.0% (75 mmol/mol), and these patients were younger than the other dropouts (mean age 54.4 [SD 10.8] years vs. 60.6 [9.4] years, p < 0.001). Median low-density lipoprotein (LDL) cholesterol level was 2.8 (QR 2.1, 3.4) mmol/l. Median systolic blood pressure (BP) was 142 (QR 130, 160) mm Hg. Median diastolic BP was 86 (78, 94) mm Hg. Of the dropouts, 83% had comorbidities and 62% were prescribed metformin as a treatment.

Conclusions: Ten percent of T2D patients were dropouts of whom those with a poor glycaemic control were younger than the other dropouts. BP and LDL cholesterol concentrations were non-optimal among the majority of the dropouts. Metformin was prescribed less frequently to the dropouts than is usual for T2D patients. The comorbidities were equally common among the dropouts as among the other T2D patients.

KEY POINTS

•   Which kinds of patients are dropouts from type-2 diabetes care is not known.

• • One-tenth of the patients with T2D were dropouts and they generally had good glycaemic control.

• • Blood pressure and LDL cholesterol concentrations were non-optimal among the majority of the dropouts.

• • Fourteen percent of these dropouts had HbA_1c > 9% (75 mmol/mol) and they were more often younger than the other dropouts.

Keywords:

• Characteristics
• comorbidities
• dropout
• Finland
• general practice
• type 2 diabetes

Acknowledgements

We would like to thank diabetes nurses of Vantaa city for contacting the dropouts. We thank Dr. Michael Horwood for reviewing the language.

Ethical approval

Ethical permission for the study was granted by the Ethical committee of the Hospital District of Helsinki and Uusimaa and health authority of the Vantaa City.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Funding information

The Hospital District of Helsinki and Uusimaa awarded a research grant (ERVA) for this study.