Management of type 2 diabetes mellitus in greenland, 2008: Examining the quality and organization of diabetes care

Abstract

Objectives. To analyse the management of type 2 diabetes mellitus (T2DM) in Greenland in 2008. Study design. Observational and cross-sectional study, including a review of medical records and databases. Methods. Data on adult (>19 years old) T2DM patients were collected from each primary health care centre in Greenland. Information was collected about age, gender, HbA1c, blood pressure, blood lipids, and from eye, feet and urine examinations from 15 of the 17 health care districts in Greenland, which represent 90% of the whole adult population of Greenland. Three clinics were excluded because of too few patients (only 7). The management of T2DM patients is described and is based on 6 processes and 3 biological indicators. Results. The 12 clinics together performed quite well looking at the monitoring of HbA1c (79%), blood pressure (69%) and blood lipids (83%). However, the screening rates were low within 2 years for microalbuminuria (47%), eye (50%) and foot examinations (29%). Great variation in the management of the treatment was observed among the clinics. No clinic achieved all the standards suggested in this paper. Screening for diabetic retinopathy seemed to be implemented, but the records were not fully updated, whereas screening for microalbuminuria and foot examinations clearly were not routine in most clinics. Conclusions. The management of type 2 diabetes mellitus is a major task for the heath care system in Greenland. It is recommended that the implementation of a national strategy based on national guidelines, local diabetes registers and feedback to the clinics get underway as soon as possible.