Optimal type 2 diabetes management including benchmarking and standard treatment: the Belgian "OPTIMISE" trial

Abstract

Background. An intense diabetic patient care using effective interventions and treatments can significantly reduce the burden of diabetes complications. Benchmarking is a comparative technique that may improve the quality of care. It consists of providing feedback on physician’s individual performance compared with preset targets, according to current guidelines, and mean performance of a peer group. The OPTIMISE study aims to assess the effect of benchmarking on the quality of care in type 2 diabetic patients during a 12-month period in 6 European countries. Methods. For Belgium, 94 General practitioners (GPs) with 1126 patients are assigned to the benchmark group and 93 GPs with 1010 patients to the control group, after cluster randomisation. The benchmark group will receive feedback on their patients’ cardiovascular risk factors (individual performance) and an anonymous comparison with their colleagues (peer group), while the control group will only receive feedback on individual performance. The primary endpoint is the percentage of patients achieving preset targets according to European guidelines (2007) for HbA1c (7%), low-density lipoprotein cholesterol (LDL-C <80 mg/dl) and Systolic Blood Pressure (SBP <130 mmHg). Results presented hereafter describe the Belgian baseline data. Results. Both groups were very well-matched for all important baseline parameters. Mean age (SD) was 66.9 years (10.6), with 53.6% men. Mean age at diabetes diagnosis was 59.3 years (11.0), with a mean 7.6 years (6.6) elapsed since diagnosis. The target HbA1c was reached in 59% of patients with a mean baseline value of 7,05% (SD1.1). Biguanides were most frequently used (75%), followed by sulfamides (45%) while only 8% received insulin. Half of the patients received a monotherapy, especially with biguanides (62%) or sulfamides (26%). Biguanides-sulfamides were also most often used as combination therapy (46%). 62% of Diabetic patients achieving the HbA1c target were treated with monotherapy. For LDL-C, 27% of patients achieved the target <80mg/dl. Mean baseline values for LDL-C was 101 mg/dL (SD32). Lipid-lowering drugs, predominantly statins (93%), were given to 65% of the patients. The most frequently used statin and their respective dose were: simvastatin 39%, 20mg (>52%); rosuvastatin 28%, 10mg (>83%) and atorvastatin 24%, 20 mg (>53%). Half of the patients receiving rosuvastatin 10 mg achieved the LDL-C goal <80mg/dl, for 20 mg atorvastatine this was 33% and 35% for 40 mg simvastatine. Eighty percent of patients were hypertensive and 76% was treated. The target blood pressure was reached in only 29% with a mean baseline value of 137 (SD16) mmHg. Beta Blockers, diuretics and ace-inhibitors were most frequently used (respectively 51, 47 and 39%). 76% of the patientsreceived a combination therapy. Of the treated hypertensive patients achieving the SBP goal 74% was on ≤ 2 antihypertensives. The majority of the patients was non-smoker (60%), performed at least weakly a light physical activity (76%) and received recently a dietary counselling (83%). Half of the patients were treated with a combination of an antidiabetic, antihypertensive and lipid lowering treatment. However, only 4 % of patients reached all 3 three preset targets. Conclusions. While lifestyle changes and multiple drug treatment are becoming current practice in the care of type 2 diabetes patients in Belgium, achievement of important targets is suboptimal. Therefore interventions to improve the quality and intensity of the diabetes care are necessary. The OPTIMISE study will evaluate the effect of benchmarking on quality of type 2 diabetes care in general practice.