Publications
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Bakken, Inger Johanne Landsjøåsen; Ruiz, Paz Lopez-Doriga; Furu, Kari; Gulseth, Hanne Løvdal; Sveen, Kari Anne & Nøkleby, Kjersti
[Show all 9 contributors for this article]
(2026).
Clinical Characteristics of Users of Weight Loss Drugs: Population-Based Case–Control Study.
Diabetes, obesity and metabolism.
ISSN 1462-8902.
28(7),
p. 6312–6323.
doi:
10.1111/dom.70827.
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Objectives: To investigate clinical characteristics of weight loss drugs (WLDs) users in Norway.
Design: Nested population-based case-control study.
Setting: Nationwide healthcare registries with data on dispensed medications and healthcare diagnoses.
Participants: Individuals aged 18-74 years initiating WLDs during 2023–2024, categorized by drugs: semaglutide (only Wegovy), liraglutide (only Saxenda), tirzepatide, bupropion-naltrexone, or orlistat. Each WLD user was matched with five age- and sex-matched population controls.
Main outcome measures: Comorbidities diagnosed in the two years preceding initiation of WLD use and comedications dispensed in the preceding year, analysed using conditional logistic regression.
Results: 150,036 individuals initiated semaglutide, 4,603 liraglutide, 3,596 tirzepatide, 31,172 bupropion–naltrexone, and 1,411 orlistat. Among WLD users, 71-78% were registered with at least one comorbidity, compared to 49-51% in controls. 19-24% of WLD users had 4 or more comorbidities. Hypertension was observed among 32-38% of WLD users vs. 17-20% of controls; hyperlipidaemias: 20-24% vs. 12-15%; sleep apnoea: 7-11% vs. 2-3%; back pain: 15-20% vs. 10-11%; opioids: 24-30% vs. 13-15%; antidepressants: 20-24% vs. 10-11%. Having only basic level of education (<=10 years) was more common among WLD users than among controls (20-28% vs 17%), except for tirzepatide users where education level distribution was as for controls.
Conclusions: WLD use is rapidly increasing, with users often having complex comorbidity. Understanding these patterns helps ensure that medications are used as intended. Like other countries with universal health systems, Norway must address the high cost of obesity treatments and mitigate health disparities to ensure access for those most likely to benefit.
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Tibelles, Hatuia Bø; Jenum, Anne Karen; Kirkebøen, Lars Johannessen; Berg, Tore Julsrud; Claudi, Tor & Cooper, John
[Show all 10 contributors for this article]
(2024).
High prevalence of retinopathy in young-onset type 2 diabetes and possible sex differences: insights from Norwegian general practice.
BMJ Open Diabetes Research & Care.
12(1).
doi:
10.1136/bmjdrc-2023-003624.
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Introduction People with young-onset type 2 diabetes (YOD), defined as diabetes diagnosis before age 40, have a high lifetime risk of vascular complications. We aimed to estimate the prevalence of YOD among adults with type 2 diabetes (T2D) in Norwegian general practice and explore associations between age at diabetes diagnosis and retinopathy overall and in men and women. Research design and methods We collected cross-sectional data from general practice electronic medical records of 10 241 adults with T2D in 2014, and repeated measurements of hemoglobin A1c (HbA1c) from 2012 to 2014. Using multivariate logistic regression, we assessed associations between YOD and later-onset T2D, sex and retinopathy. Results Of all individuals with T2D, 10% were diagnosed before 40 years of age in both sexes. Compared with later-onset T2D, HbA1c increased faster in YOD, and at the time of diagnosis HbA1c was higher in men, particularly in YOD. Retinopathy was found in 25% with YOD, twice as frequently as in later onset. After adjustments for confounders (age, country of origin, education, body mass index), OR of retinopathy was increased in both men with YOD (OR 2.6 (95% CI 2.0 to 3.5)) and women with YOD (OR 2.2 (1.5 to 3.0)). After further adjustments for potential mediators (diabetes duration and HbA1c), the higher OR persisted in men with YOD (OR 1.8 (1.3 to 2.4)) but was attenuated and no longer significant for women with YOD. Conclusions Retinopathy prevalence was more than twice as high in YOD as in later-onset T2D. The increased likelihood of retinopathy in YOD was partly mediated by higher HbA1c and longer T2D duration, but after accounting for these factors it remained higher in men with YOD.
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Ruiz, Paz Lopez-Doriga; Karlstad, Øystein; Nøkleby, Kjersti; Slåtsve, Kristina Barbara; Gulseth, Hanne Løvdal & Meyer, Haakon E.
[Show all 9 contributors for this article]
(2024).
Pharmacological treatment of obesity in adults in Norway 2004–2022.
Diabetes, obesity and metabolism.
ISSN 1462-8902.
26(6),
p. 2102–2110.
doi:
10.1111/dom.15515.
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Aims To describe trends in the use of anti-obesity drugs in Norway during the period 2004–2022. Materials and Methods We assessed the annual utilization of any available drug indicated for obesity recorded in the nationwide Norwegian Prescribed Drug Register for adults (age 18–79 years) from 1 January 2004 to 31 December 2022. Prevalence was stratified by sex and age group (18–29 years and 10-year age groups thereafter). Additional analyses were performed in individuals initiating treatment with an anti-obesity drug and on the cost of the anti-obesity drugs since 2017. Results The prevalence of anti-obesity drug use decreased from 2009, when sibutramine and rimonabant were withdrawn from the market, and increased again after the approval of bupropion-naltrexone in 2017 and liraglutide in 2018. The use of the peripheral-acting anti-obesity drug orlistat decreased from 2004. In 2022, 1.04% of the adult Norwegian population (72.8% women) filled at least one prescription of bupropion-naltrexone, 0.91% used liraglutide (Saxenda; 74.2% women), and semaglutide without reimbursement was used by 0.68% (76.7% women). The prevalence increased with age, peaking in the age group 50 to 59 years, and decreased in older age groups. From 2017 to 2022, 2.8% of the adult residents initiated treatment with an anti-obesity drug. The total sale of those drugs increased from 1.1 million euros in 2017 to 91.8 million euros in 2022. Conclusions The use of anti-obesity drugs in Norway has increased substantially in recent years, especially among women aged 40 to 59 years. Changes in availability and reimbursement have influenced the use of these drugs in recent years.
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Nøkleby, Kjersti; Jenum, Anne Karen; Buhl, Esben Selmer; Claudi, Tor; Cooper, John & Flottorp, Signe Agnes
[Show all 9 contributors for this article]
(2024).
Effects on HbA1c of referral of type 2 diabetes patients to secondary care.
Scandinavian Journal of Primary Health Care.
ISSN 0281-3432.
p. 1–11.
doi:
10.1080/02813432.2024.2433107.
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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.
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Mdala, Ibrahimu; Nøkleby, Kjersti; Berg, Tore Julsrud; Cooper, John; Sandberg, Sverre & Løvaas, Karianne Fjeld
[Show all 9 contributors for this article]
(2023).
Insulin initiation in patients with type 2 diabetes is often delayed, but access to a diabetes nurse may help—insights from Norwegian general practice.
Scandinavian Journal of Primary Health Care.
ISSN 0281-3432.
42(1).
doi:
10.1080/02813432.2023.2296118.
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Objective: We opted to study how support staff operational capacity and diabetes competences may impact the timeliness of basal insulin-initiation in general practice patients with type 2 diabetes (T2D). Design/Setting/Outcomes: This was an observational and retrospective study on Norwegian primary care patients with T2D included from the ROSA4-dataset. Exposures were (1) support staff size, (2) staff size relative to number of GPs, (3) clinic access to a diabetes nurse and (4) share of staff with diabetes course (1 and 2 both relate to staff operational capacity, whereas 3 and 4 are both indicatory of staff diabetes competences). Outcomes were ‘timely basal insulin-initiation’ (primary) and ‘attainment of HbA1c<7%’ after insulin start-up (secondary). Associations were analyzed using multiple linear regression, and directed acyclic graphs guided statistical adjustments. Subjects: Insulin naïve patients with ‘timely’ (N = 294), ‘postponed’ (N = 219) or ‘no need of’ (N = 3,781) basal insulin-initiation, respectively. Results: HbA1c [median (IQR)] increased to 8.8% (IQR, 8.0, 10.2) prior to basal insulin-initiation, which reduced HbA1c to 7.3 (6.8–8.1) % by which only 35% of the subjects reached HbA1c <7%. Adjusted risk of ‘timely basal insulin-initiation’ was more than twofold higher if access to a diabetes nurse (OR = 2.40, [95%CI, 1.68, 3.43]), but related only vaguely to staff size (OR = 1.01, [95%CI, 1.00, 1.03]). No other staff factors related significantly to neither the primary nor the secondary outcome. Conclusion: In Norwegian general practice, insulin initiation in people with T2D may be affected by therapeutic inertia but access to a diabetes nurse may help facilitating more timely insulin start-up.
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Forster, Rachel Bedenis; Strandberg, Ragnhild Bjarkøy; Tibballs, Katrina Louise Bø; Nøkleby, Kjersti; Berg, Tore Julsrud & Iversen, Tor
[Show all 15 contributors for this article]
(2022).
Cohort profile: Outcomes & Multi-morbidity In Type 2 diabetes (OMIT) - a national registry-based observational cohort with focus on care and treatment of key high-risk groups in Norway.
BMJ Open.
12(5).
doi:
10.1136/bmjopen-2021-054840.
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Purpose The ‘Outcomes & Multi-morbidity in Type 2 Diabetes’ (OMIT) is an observational registry-based cohort of Norwegian patients with type 2 diabetes (T2D) established to study high-risk groups often omitted from randomised clinical trials. Participants The OMIT cohort includes 57 572 patients with T2D identified via linkage of Norwegian Diabetes Register for Adults and the Rogaland-Oslo-Salten-Akershus-Hordaland study, both offering data on clinical patient characteristics and drug prescriptions. Subsequently these data are further linked to the Norwegian Prescription Database for dispensed medications, the Norwegian Population Register for data on death and migration, Statistics Norway for data on socioeconomic factors and ethnicity and the Norwegian Directorate of Health for data on the general practices and clinical procedures involved in the care of cohort patients. OMIT offers large samples for key high-risk patient groups: (1) young-onset diabetes (T2D at age <40 years) (n=6510), (2) elderly (age >75 years) (n=15 540), (3) non-Western ethnic minorities (n=9000) and (4) low socioeconomic status (n=20 500). Findings to date On average, patient age and diabetes duration is 67.4±13.2 and 12.3±8.3 years, respectively, and mean HbA1c for the whole cohort through the study period is 7.6%±1.5% (59.4±16.3 mmol/mol), mean body mass index (BMI) and blood pressure is 30.2±5.9 kg/m2 and 135±16.1/78±9.8 mm Hg, respectively. Prevalence of retinopathy, coronary heart disease and stroke is 10.1%, 21% and 6.7%, respectively. Future plans The OMIT cohort features 5784 subjects with T2D in 2006, a number that has grown to 57 527 in 2019 and is expected to grow further via repeated linkages performed every third to fifth year. At the next wave of data collection, additional linkages to Norwegian Patient Registry and Norwegian Cause of Death Registry for data on registered diagnoses and causes of death, respectively, will be performed.
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Slåtsve, Kristina Barbara; Claudi, Tor; Lappegård, Knut Tore; Jenum, Anne Karen; Larsen, Marthe & Nøkleby, Kjersti
[Show all 12 contributors for this article]
(2022).
Level of education is associated with coronary heart disease and chronic kidney disease in individuals with type 2 diabetes: a population-based study.
BMJ Open Diabetes Research & Care.
10(5).
doi:
10.1136/bmjdrc-2022-002867.
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Introduction - To study the relationship between education level and vascular complications in individuals with type 2 diabetes in Norway.<p> <p>Research design and methods - Multiregional population-based cross-sectional study of individuals with type 2 diabetes in primary care. Data were extracted from electronic medical records in the period 2012–2014. Information on education level was obtained from Statistics Norway. Using multivariable multilevel regression analyses on imputed data we analyzed the association between education level and vascular complications. We adjusted for age, sex, HbA1c, low-density lipoprotein cholesterol, systolic blood pressure, smoking and diabetes duration. Results are presented as ORs and 95% CIs.<p> <p>Results - Of 8192 individuals with type 2 diabetes included, 34.0% had completed compulsory education, 49.0% upper secondary education and 16.9% higher education. The prevalence of vascular complications in the three education groups was: coronary heart disease 25.9%, 23.0% and 16.9%; stroke 9.6%, 7.4% and 6.6%; chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m2) 23.9%, 16.8% and 12.6%; and retinopathy 13.9%, 11.5% and 11.7%, respectively. Higher education was associated with lower odds for coronary heart disease (OR 0.59; 95% CI 0.49 to 0.71) and chronic kidney disease (OR 0.75; 95% CI 0.60 to 0.93) compared with compulsory education when adjusting for age, sex, HbA1c, low-density lipoprotein cholesterol, systolic blood pressure, smoking and diabetes duration.<p> <p>Conclusions - In a country with equal access to healthcare, high education level was associated with lower odds for coronary heart disease and chronic kidney disease in individuals with type 2 diabetes.
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Slåtsve, Kristina Barbara; Claudi, Tor; Lappegård, Knut Tore; Jenum, Anne Karen; Larsen, Marthe & Nøkleby, Kjersti
[Show all 9 contributors for this article]
(2021).
Factors associated with treatment in primary versus specialist care: A population-based study of people with type 2 and type 1 diabetes.
Diabetic Medicine.
ISSN 0742-3071.
38(7).
doi:
10.1111/dme.14580.
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Aims The objectives of this study are to identify the proportion and characteristics of people with type 1 and 2 diabetes treated in primary, specialist and shared care and to identify the proportion of persons with type 2 diabetes reaching HbA1c treatment targets and the clinical risk factors and general practitioner and practice characteristics associated with treatment in specialist care. Methods Population-based cross-sectional study including all adults ≥18 years diagnosed with diabetes in primary and specialist care in Salten, Norway. We used multivariable mixed-effects logistic regression models with level of care as outcome variable and population, general practitioner, and practice characteristics as exposure variables. Results Of 2704 people with type 2 diabetes, 13.5% were treated in shared care and 2.1% in specialist care only. Of 305 people with type 1 diabetes, 14.4% received treatment in primary care only. The HbA1c treatment target of 53 mmol/mol (7.0%) was reached by 67.3% of people with type 2 diabetes in primary care versus 30.4% in specialist care. HbA1c, use of insulin, coronary heart disease, retinopathy and urban practice location were positively associated with treatment in specialist care. General practitioners’ use of a structured form and a diabetes nurse were negatively associated with specialist care. Conclusions Of people with type 2 diabetes, 16% were treated in specialist care. They had higher HbA1c and more vascular complications, as expected from priority guidelines. The use of a structured diabetes form and diabetes nurses seem to support type 2 diabetes follow-up in primary care.
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Nøkleby, Kjersti; Berg, Tore Julsrud; Mdala, Ibrahimu; Buhl, Esben Selmer; Claudi, Tor & Cooper, John
[Show all 9 contributors for this article]
(2021).
High adherence to recommended diabetes follow-up procedures by general practitioners is associated with lower estimated cardiovascular risk.
Diabetic Medicine.
ISSN 0742-3071.
38(8),
p. 1–11.
doi:
10.1111/dme.14586.
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Aims To explore whether the general practitioners’ (GPs’) performance of recommended processes of care was associated with estimated risk of cardiovascular disease (CVD) and poor glycaemic control in patients with type 2 diabetes. Methods A cross-sectional study from Norwegian general practice including 6015 people with type 2 diabetes <75 years old, without CVD and their 275 GPs. The GPs were split into quintiles based on each GP’s average performance of six recommended processes of care. The quintiles were the exposure variable in multilevel regression models with 10-year risk of cardiovascular events estimated by NORRISK 2 (total and modifiable fraction) and poor glycaemic control (HbA1c >69 mmol/mol (>8.5%)) as outcome variables. Results The mean total and modifiable estimated 10-year CVD risk was 12.3% and 3.3%, respectively. Compared with patients of GPs in the highest-performing quintile, patients treated by GPs in the lowest quintile had an adjusted total and modifiable CVD risk that was 1.88 (95% CI 1.17–2.60) and 1.78 (1.14–2.41) percent point higher. This represents a relative mean difference of 16.6% higher total and 74.8% higher modifiable risk among patients of GPs in the lowest compared with the highest quintile. For patients with GPs in the lowest-performing quintile, the adjusted odds of poor glycaemic control was 1.77 (1.27–2.46) times higher than that for patients with a GP in the highest quintile. Conclusions We found a pattern of lower CVD risk and better glycaemic control in patients of GPs performing more recommended diabetes processes of care.
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Nøkleby, Kjersti; Berg, Tore Julsrud; Mdala, Ibrahimu; Tran, Anh Thi; Bakke, Åsne & Gjelsvik, Bjørn E.
[Show all 12 contributors for this article]
(2020).
Variation between general practitioners in type 2 diabetes processes of care.
Primary Care Diabetes.
ISSN 1751-9918.
15(3),
p. 1–7.
doi:
10.1016/j.pcd.2020.11.018.
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Aims To explore variation in general practitioners’ (GPs’) performance of six recommended procedures in type 2 diabetes patients <75 years without cardiovascular disease. Methods Cross-sectional study of quality of diabetes care in Norway based on electronic health records from 2014. GPs (clustered in practices) were divided in quintiles based on a composite measure of performance of six processes of care. We fitted a multilevel partial ordinal regression model to identify GP factors associated with being in quintiles with better performance. Results We identified 6015 type 2 diabetes patients from 275 GPs in 77 practices. The GPs performed on average 63.4% of the procedures; on average 46% in the poorest quintile to 81% in the best quintile with a larger range in individual GPs. After adjustments, use of a structured follow-up form was associated with GPs being in upper three quintiles (OR 12.4 (95% CI 2.37–65.1). Routines for reminders were associated with being in a better quintile (OR 2.6 (1.37–4.92). GPs’ age >60 years and heavier workload were associated with poorer performance. Conclusion We found large variations in GPs’ performance of processes of care. Factors reflecting structure and workload were strongly associated with performance.
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Tran, Anh Thi; Berg, Tore Julsrud; Gjelsvik, Bjørn E.; Mdala, Ibrahimu; Thue, Geir & Cooper, John
[Show all 11 contributors for this article]
(2019).
Ethnic and gender differences in the management of type 2 diabetes: a cross-sectional study from Norwegian general practice.
BMC Health Services Research.
19:903,
p. 1–11.
doi:
10.1186/s12913-019-4557-4.
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Background: Ethnic minority groups from Asia and Africa living in Western countries have a higher prevalence of type 2 diabetes (T2DM) than the general population. We aimed to assess ethnic differences in diabetes care by gender. Methods: Population-based, cross-sectional study identified 10,161 individuals with T2DM cared for by 282 General Practitioners (GP) in Norway. Ethnicity was based on country of birth. Multilevel regression models adjusted for individual and GP factors were applied to evaluate ethnic differences by gender. Results: Diabetes was diagnosed at a younger mean age in all other ethnic groups compared with Westerners (men: 45.9–51.6 years vs. 56.4 years, women: 44.9–53.8 years vs. 59.1 years). Among Westerners mean age at diagnosis was 2.7 years higher in women compared with men, while no gender difference in age at diagnosis was found in any minority group. Daily smoking was most common among Eastern European, South Asian and Middle East/North African men. In both genders, we found no ethnic differences in processes of care (GPs’ measurement of HbA1c, blood pressure, LDL-cholesterol, creatinine). The proportion who achieved the HbA1c treatment target was higher in Westerners (men: 62.3%; women: 66.1%), than in ethnic minorities (men 48.2%; women 53.5%). Compared with Western men, the odds ratio (OR) for achieving the target was 0.45 (95% CI 0.27 to 0.73) in Eastern European; 0.67 (0.51 to 0.87) in South Asian and 0.62 (0.43 to 0.88) in Middle Eastern/North African men. Compared with Western women, OR was 0.49 (0.28 to 0.87) in Eastern European and 0.64 (0.47 to 0.86) South Asian women. Compared with Westerners, the blood pressure target was more often achieved in South Asians and Middle Easterners/North Africans in both genders. Small ethnic differences in achieving the LDL-cholesterol treatment target by gender were found. Conclusion: Diabetes was diagnosed at a considerably earlier age in both minority men and minority women compared with Westerners. Several minority groups had worse glycaemic control compared with Westerners in both genders, which implies that it is necessary to improve glucose lowering treatment for the minority groups. Smoking cessation advice should particularly be offered to men in most minority groups.
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Gjelsvik, Bjørn E.; Tran, Anh Thi; Berg, Tore Julsrud; Bakke, Åsne; Mdala, Ibrahimu & Nøkleby, Kjersti
[Show all 12 contributors for this article]
(2019).
Exploring the relationship between coronary heart disease and type 2 diabetes: a cross-sectional study of secondary prevention among diabetes patients.
British Journal of General Practice Open.
doi:
10.3399/bjgpopen18X101636.
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Background: Coronary heart disease (CHD) and stroke are the major causes of death among people with diabetes. Aim: To describe the prevalence and onset of CHD and stroke among patients with type 2 diabetes mellitus (T2DM) in primary care in Norway, and explore the quality of secondary prevention. Design & setting: A cross-sectional study of data was undertaken from electronic medical records (EMRs) of 10 255 patients with T2DM in general practice. The study took place in five counties of Norway (Oslo, Akershus, Rogaland, Hordaland, and Nordland). Quality of care was assessed based on national guideline recommendations. Method: Summary statistics with adjustments and binary logistic regression models were used. Results: In total, 2260 patients (22.1%) had CHD and 759 (7.4%) had stroke. South Asians had significantly more CHD than ethnic Norwegians (29.5%, 95% confidence interval [CI] = 26.1 to 33.0 versus 21.5%, CI = 20.6 to 22.3) and other ethnic groups, and experienced onset of CHD or stroke at a mean of 7 years before Norwegians. In 47.9% of the patients, CHD was diagnosed before T2DM. Treatment target for low-density lipoprotein (LDL) cholesterol was reached for 30.0% and for systolic blood pressure (SBP) for 65.1% of the patients with CHD. Further, 20.9% of patients with CHD were present smokers, and only 5.0% of patients reached all four treatment targets (no smoking, HbA1c ≤7.0%, SBP <135 mmHg, LDL-cholesterol <1.8 mmol/l). Conclusion: The diagnosis of CHD preceded the diagnosis of T2DM in half of the patients. The prevalence of CHD was highest and onset earlier among ethnic South Asians. More intensive treatment of lipids, blood pressure, and smoking are needed in patients with T2DM and CHD.
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Tran, Anh Thi; Bakke, Åsne; Berg, Tore Julsrud; Gjelsvik, Bjørn E.; Mdala, Ibrahimu & Nøkleby, Kjersti
[Show all 13 contributors for this article]
(2018).
Are general practitioners characteristics associated with the quality of type 2 diabetes care in general practice? Results from the Norwegian ROSA4 study from 2014.
Scandinavian Journal of Primary Health Care.
ISSN 0281-3432.
36(2),
p. 170–179.
doi:
10.1080/02813432.2018.1459238.
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Objective: To explore the associations between general practitioners (GPs) characteristics such as gender, specialist status, country of birth and country of graduation and the quality of care for patients with type 2 diabetes (T2DM). Design: Cross-sectional survey. Setting and subjects: The 277 GPs provided care for 10082 patients with T2DM in Norway in 2014. The GPs characteristics were self-reported: 55% were male, 68% were specialists in General Practice, 82% born in Norway and 87% had graduated in Western Europe. Of patients, 81% were born in Norway and 8% in South Asia. Data regarding diabetes care were obtained from electronic medical records and manually verified. Main outcome measures: Performance of recommended screening procedures, prescribed medication and level of HbA1c, blood pressure and LDL-cholesterol stratified according to GPs characteristics, adjusted for patient and GP characteristics. Result: Female GPs, specialists, GPs born in Norway and GPs who graduated in Western Europe performed recommended procedures more frequently than their counterparts. Specialists achieved lower mean HbA1c (7.14% vs. 7.25%, p < 0.01), a larger proportion of their patients achieved good glycaemic control (HbA1c = 6.0%–7.0%) (49.1% vs. 44.4%, p = 0.018) and lower mean systolic blood pressure (133.0 mmHg vs. 134.7 mmHg, p < 0.01) compared with non-specialists. GPs who graduated in Western Europe achieved lower diastolic blood pressure than their counterparts (76.6 mmHg vs. 77.8 mmHg, p < 0.01). Conclusion: Several quality indicators for type 2 diabetes care were better if the GPs were specialists in General Practice.
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Aug. 21, 2017 1:27 PM
- Last modified
Aug. 21, 2017 1:27 PM