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. 2020 Oct 30;30(11):1945-1953.
doi: 10.1016/j.numecd.2020.08.018. Epub 2020 Aug 22.

A view on the quality of diabetes care in Italy and the role of Diabetes Clinics from the 2018 ARNO Diabetes Observatory

Enzo Bonora  1 , Salvatore Cataudella  2 , Giulio Marchesini  3 , Roberto Miccoli  3 , Olga Vaccaro  3 , Gian Paolo Fadini  3 , Nello Martini  4 , Elisa Rossi  2
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A view on the quality of diabetes care in Italy and the role of Diabetes Clinics from the 2018 ARNO Diabetes Observatory

Enzo Bonora et al. Nutr Metab Cardiovasc Dis. .

Abstract

Backgrounds and aims: To investigate relevant indicators of quality of care in a large population-based sample of people with diabetes representative of clinical practice in Italy in 2018.

Methods and results: We analyzed data from 11,300,750 subjects. All administrative healthcare claims collected in 2018 were scrutinized to identify subjects with diabetes and investigate several indicators of quality of care. Subjects with diabetes were identified by anti-hyperglycemic drug prescriptions, disease-specific co-payment exemption and hospital discharge codes. Indicators of quality of care pertained to monitoring (HbA1c, creatinine, lipid profile, microalbuminuria, eye examination, ECG, ultrasonography of carotid and lower limb arteries) and diabetes treatment (anti-hyperglycemic agents in subjects with cardiovascular disease, CVD). Subjects attending and nonattending Diabetes Clinics were compared. We identified 697,208 individuals with diabetes. HbA1c was assessed at least once in the year in 62.7%, creatinine in 62.3%, total cholesterol in 59.6%, microalbuminuria in 34.3%. Frequency of eye examination was 8.2%, ECG 23.5%, carotid ultrasonography 14.3%, lower limb ultrasonography 7.6%. Among anti-hyperglycemic drugs, SGLT-2 inhibitors were prescribed to ~5% and GLP-1 receptor agonists to ~5% although the proportion of subjects with CVD was ~45%. Subjects attending Diabetes Clinics had higher figures for all these monitoring and treatment indicators.

Conclusions: The implementation of national and international guidelines regarding disease monitoring and treatment is far from being satisfactory, especially among subjects nonattending Diabetes Clinics. Further efforts and investments are needed for better disseminating guidelines, more efficaciously engaging healthcare professionals and more strongly empowering the healthcare system to improve diabetes care.

Keywords: Adherence; Anti-hyperglycemic agents; Diabetes mellitus; Monitoring; Quality of care.

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Conflict of interest statement

Declaration of competing interest EB received honoraria for participating in advisory boards of Abbott, Astrazeneca, Becton Dickinson, Boehringer Ingelheim, Bristol-Myers Squibb, Bruno Farmaceutici, Janssen, Johnson&Johnson, Lilly, MSD, Mundipharma, Novartis, Novo Nordisk, Roche, Sanofi, Servier, Takeda. GM received honoraria for participating in advisory boards from Pfizer, Gilead, Novartis, Eli Lilly, Mundipharma. GPF received honoraria or lecture fees from Abbott, AstraZeneca, Boehringer, Lilly, MSC, Mundipharma, Novartis, Novonordisk, Sanofi, Servier.pharma, Novartis, Novonordisk, Sanofi, Servier.

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