How to diagnose and classify diabetes in primary health care: Lessons learned from the Diabetes Register in Northern Sweden (DiabNorth)

Abstract Objective. The objective was to create a diabetes register and to evaluate the validity of the clinical diabetes diagnosis and its classification. Design. The diabetes register was created by linkage of databases in primary and secondary care, the pharmaceutical database, and ongoing population-based health surveys in the county. Diagnosis and classification were validated by specialists in diabetology or general practitioners with special competence in diabetology. Analysis of autoantibodies associated with type 1 diabetes was used for classification. Setting. Primary and secondary health care in the county of Västerbotten, Sweden. Patients. Patients with diabetes (median age at diagnosis 56 years, inter quartile range 50–60 years) who had participated in the Västerbotten Intervention Programme (VIP) and accepted participation in a diabetes register. Results. Of all individuals with diabetes in VIP, 70% accepted to participate in the register. The register included 3256 (M/F 1894/1362) diabetes patients. The vast majority (95%) had data confirming the diabetes diagnoses according to WHO recommendations. Unspecified diabetes was the most common (54.6%) classification by the general practitioners. After assessment by specialists and analysis of autoantibodies the majority were classified as type 2 diabetes (76.8%). Type 1 diabetes was the second largest group (7.2%), including a sub-group of patients with latent autoimmune diabetes (4.8%). Conclusion. It was concluded that it is feasible to create a diabetes register based on information in medical records in general practice. However, special attention should be paid to the validity of the diabetes diagnosis and its classification.

[1]  J. Sundquist,et al.  Country of birth, socioeconomic factors, and risk factor control in patients with type 2 diabetes: a Swedish study from 25 primary health‐care centres , 2011, Diabetes/metabolism research and reviews.

[2]  H. Stenlund,et al.  Increasing glucose concentrations and prevalence of diabetes mellitus in northern Sweden, 1990–2007 , 2010, Global health action.

[3]  O. Rolandsson,et al.  Latent autoimmune diabetes in adults (LADA) is dead: long live autoimmune diabetes! , 2010, Diabetologia.

[4]  L. Weinehall,et al.  The Västerbotten Intervention Programme: background, design and implications , 2010, Global health action.

[5]  B. Wells,et al.  Health Care and Productivity Costs Associated With Diabetic Patients With Macrovascular Comorbid Conditions , 2009, Diabetes Care.

[6]  G. Hallmans,et al.  Low agreement between radio binding assays in analyzing glutamic acid decarboxylase (GAD65Ab) autoantibodies in patients classified with type 2 diabetes , 2009, Autoimmunity.

[7]  R. Root-Bernstein,et al.  Antigenic complementarity between coxsackie virus and streptococcus in the induction of rheumatic heart disease and autoimmune myocarditis , 2009, Autoimmunity.

[8]  C. Petersson,et al.  Incidence of type 1 and type 2 diabetes in adults and children in Kronoberg, Sweden. , 2008, Diabetes research and clinical practice.

[9]  K. Svärdsudd,et al.  Prevalence and incidence rate of diabetes mellitus in a Swedish community during 30 years of follow-up , 2007, Diabetologia.

[10]  O. Rolandsson,et al.  Latent autoimmune diabetes in adults (LADA) should be less latent , 2005, Diabetologia.

[11]  Lars-Erik Strender,et al.  Collection and retrieval of structured clinical data from electronic patient records in general practice A first-phase study to create a health care database for research and quality assessment , 2004, Scandinavian journal of primary health care.

[12]  Å. Lernmark,et al.  A novel radioligand binding assay to determine diagnostic accuracy of isoform-specific glutamic acid decarboxylase antibodies in childhood IDDM , 1994, Diabetologia.

[13]  L. Weinehall,et al.  Cardiovascular disease and diabetes in the Northern Sweden Health and Disease Study Cohort- evaluation of risk factors and their interactions , 2003, Scandinavian journal of public health. Supplement.

[14]  Peter Libby,et al.  Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. , 2002, JAMA.

[15]  J. Wautier,et al.  Advanced glycation end products, their receptors and diabetic angiopathy. , 2001, Diabetes & metabolism.

[16]  G. Sundkvist,et al.  Incidence, prevalence, and mortality of diabetes in a large population. A report from the Skaraborg Diabetes Registry. , 1999, Diabetes care.

[17]  P. Zimmet,et al.  Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO Consultation , 1998, Diabetic medicine : a journal of the British Diabetic Association.

[18]  H. Britt,et al.  The reliability and validity of doctor-recorded morbidity data in active data collection systems. , 1998, Scandinavian journal of primary health care.

[19]  R. Holman,et al.  UKPDS 25: autoantibodies to islet-cell cytoplasm and glutamic acid decarboxylase for prediction of insulin requirement in type 2 diabetes , 1997, The Lancet.

[20]  Å. Lernmark,et al.  Radioimmunoassays for glutamic acid decarboxylase (GAD65) and GAD65 autoantibodies using 35S or 3H recombinant human ligands. , 1995, Journal of immunological methods.

[21]  L. Groop,et al.  Antibodies to Glutamic Acid Decarboxylase Reveal Latent Autoimmune Diabetes Mellitus in Adults With a Non—Insulin-Dependent Onset of Disease , 1993, Diabetes.

[22]  S. Baekkeskov,et al.  Identification of the 64K autoantigen in insulin-dependent diabetes as the GABA-synthesizing enzyme glutamic acid decarboxylase , 1990, Nature.

[23]  S. Baekkeskov,et al.  Identification of the 64K autoantigen in insulin-dependent diabetes as the GABA-synthesizing enzyme glutamic acid decarboxylase , 1990, Nature.

[24]  S. Wall,et al.  Health problems in a Swedish county--what can we learn from official sources? , 1981, Social science & medicine. Part C, Medical economics.