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- Cederholm, Jan, et al.
(författare)
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Blood pressure and other cardiovascular risk factors among treated hypertensives in Swedish primary health care
- 2002
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 20:4, s. 224-229
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate antihypertensive treatment and other cardiovascular risk factors in primary health care.DESIGN: Cross-sectional survey of consecutive patients with treated hypertension in 1999.SETTING: 17 primary care centres in Sweden.SUBJECTS: 512 patients (mean age 67; SD 11 years).MAIN OUTCOME MEASURES: Antihypertensive treatment, cardiovascular risk factors.RESULTS: Patients with high diastolic BP (> or = 100 mmHg) and systolic BP (> 180 mmHg) values were few. The proportions with diastolic BP < 90, BP < 160/95 and < 140/90 mmHg were 64%, 54% and 15%. Mono-therapy was given in 51%, and > or = 3 drugs in 13%. Hypertensives with hyperlipidaemia were 42%, and only 26% of them were given lipid-lowering drugs, mainly statins, 21%. Smokers were 10%, 23% had diabetes, and many had overweight BMI = 25 kg/m2, 72%.CONCLUSION: Although two-thirds had diastolic BP < 90 mmHg, few had BP below the current treatment target < 140/90 mmHg. More than half of the hypertensives had at least one additional cardiovascular risk factor, and these hypertensives also had low proportions within several current treatment targets of hypertension and hyperlipidaemia, implying a need for intensified multiple risk factor intervention.
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- Gudbjörnsdottir, Soffia, et al.
(författare)
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Nationella diabetesregistret 1996-2003 : Kvalitetsvärdering visar att diabetesvården har förbättrats
- 2004
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 101:47, s. 3790-3797
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The Swedish National Diabetes Register presents results during the period 1996- 2003. Quality of care data from more than 75,000 diabetic patients (2003) treated at medical departments and primary health care centres are evaluated concerning national goals of HbA1c <6,5% and BP <140/85 mm Hg, the prevalence of lipid treatment, smoking etc. The national goals of HbA1c and BP were reached with increasing degree in cross-sectional analysis during the period, and were achieved by 33% and 71% at medical departments, and by 61% and 48% in primary health care in 2003. A similar tendency was also seen in longitudinal analysis of subgroups 1996-2003. The use of antihypertensive and lipid-lowering drugs was also considerably increased. This should imply a reduction of the risk for diabetic complications. As the national goals are still difficult to reach, individual goals should be set for the treatment.
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- Gudbjörnsdottir, Soffia, 1962, et al.
(författare)
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The National Diabetes Register in Sweden: an implementation of the St. Vincent Declaration for Quality Improvement in Diabetes Care
- 2003
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Ingår i: Diabetes Care. - : American Diabetes Association. - 0149-5992 .- 1935-5548. ; 26:4, s. 1270-6
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To monitor glycemic control, treatable risk factors, and treatment profile for quality assessment of diabetes care on a national scale. RESEARCH DESIGN AND METHODS: Four samples of 23,546, 32,903, 30,311, and 29,769 patients with diabetes (1996-1999) were studied based on a repeated national screening and quality assessment of diabetes care by the National Diabetes Register, Sweden, with participation of both hospitals and primary health care. Clinical characteristics included were age, sex, diabetes duration and treatment, glycemic control (HbA(1c)), office blood pressure (BP), BMI, smoking habits, and use of lipid-lowering drugs in patients with type 1 or type 2 diabetes. RESULTS: Favorable decreases of mean HbA(1c) and BP values were registered during the 4-year study period for both type 1 (HbA(1c) 7.5-7.3% and BP 130/75-130/74 mmHg) and type 2 diabetic patients (HbA(1c) 7.0-6.7% and BP 151/82-147/80 mmHg). Treatment aims of HbA(1c) and BP levels were also achieved in increasing proportions for type 1 (HbA(1c) <7.5%: 50-58% and BP
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| 7. |
- Nilsson, Peter, et al.
(författare)
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Diabetes och tobak - dubbla hot mot hälsan
- 2002
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 99:20, s. 2-2285
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Tidskriftsartikel (refereegranskat)abstract
- Smoking is a serious risk factor for cardiovascular disease, retinopathy, and nephropathy in patients with diabetes. Furthermore, epidemiological studies have shown that heavy smokers run an increased prospective risk of developing type 2 diabetes, probably due both to the fact that smoking is a marker for an unhealthy lifestyle and that smoking via nicotine may deteriorate glucose metabolism by negatively influencing insulin sensitivity. In Sweden, data from the National Diabetes Register (NDR) has shown that the prevalence of smoking in type 2 diabetes patients followed in primary health care is almost as high as in the non-diabetic population, at least in middle-aged subjects (about 20%). This alarming situation must be dealt with by using new and effective methods to promote anti-smoking. If support by group sessions can be organised for patients with type 2 diabetes who are smokers, in combination with pharmacological approaches (nicotine, bupropion) it is hoped that the rate of smoking cessation can substantially increase. Such projects are currently under-way within the primary health care in southern Sweden.
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| 8. |
- Nilsson, Peter, et al.
(författare)
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Hypertension in diabetes : trends in clinical control in repeated large-scale national surveys from Sweden
- 2003
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Ingår i: Journal of Human Hypertension. - : Springer Science and Business Media LLC. - 0950-9240 .- 1476-5527. ; 17:1, s. 37-44
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Tidskriftsartikel (refereegranskat)abstract
- Hypertension in diabetes is an important and treatable cardiovascular risk factor. Treatment targets from guidelines cannot always be achieved in everyday clinical practice. It is therefore of great importance to monitor trends in hypertension control in defined populations. Patients with type I diabetes (range 6685-10100; treated hypertension 21-29%) or with type II diabetes (range 15935-22605; treated hypertension 47-56%) were included in four national samples between 1996 and 1999. This screening was part of the procedures for the National Diabetes Register in Sweden, which monitors trends in clinical practice and risk factors for patients with diabetes, recruited both in primary health care and at the hospital level. A favourable trend in mean and median blood pressure levels was noticed during the 4-year study period, based either on data from repeated surveys or on repeated measures in the same individual, both for type I diabetes (mean: -2/-2 mmHg; P < 0.01) and for type II diabetes (mean: -5/-3 mmHg; P < 0.001). Correspondingly, the proportion of hypertensive patients in acceptable control of blood pressure (less than or equal to140/ 85 mmHg) increased (P < 0.001) both in type I diabetes (52.0-57.9%) and in type 11 diabetes (22.4-33.3%). It was concluded that hypertension is a widespread cardiovascular risk factor in patients with diabetes, especially systolic hypertension. A trend for a better systolic blood pressure control during the late 1990s in hypertensive patients with type II diabetes in Sweden could translate into substantial (estimated) clinical benefits in cardiovascular and diabetes-related morbidity. The National Diabetes Register makes a quality assessment of the hypertension treatment possible.
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- Nilsson, Peter, et al.
(författare)
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Smoking is associated with increased HbA1c values and microalbuminuria in patients with diabetes--data from the National Diabetes Register in Sweden
- 2004
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Ingår i: Diabetes Metab. - 1262-3636 .- 1878-1780. ; 30:3, s. 261-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim was to examine trends in the proportion of smoking in diabetes patients, and to study associations between smoking, glycaemic control, and microalbuminuria. METHODS: Smoking habits were reported to the Swedish National Diabetes Register (NDR), with data from hospitals and primary health care. Patient characteristics included were age, gender, type of treatment, diabetes duration, HbA1c, BMI, blood pressure, antihypertensive and lipid-lowering drugs, and microalbuminuria. RESULTS: The proportion of smokers in type 1 diabetes was 12-15% during 1996-2001, it was high in females<30 years (12-16%), and was higher in the age group 30-59 years (13-17%) than in older (6-9%) patients. The corresponding proportion of smoking in type 2 diabetes was 10-12%, higher in those less than 60 years of age (17-22%) than in older (7-9%) patients. Smoking type 1 and type 2 patients in 2001 had higher mean HbA1c but lower mean BMI values than non-smokers. Smokers also had higher frequencies of microalbuminuria, in both type 1 (18 vs 14%) and type 2 (20% vs 13%) diabetes. Multiple logistic regression analyses disclosed that smoking was independently associated with elevated HbA1c levels (p<0.001) and microalbuminuria (p<0.001), but negatively with BMI (p<0.001), in both type 1 and type 2 diabetes. CONCLUSIONS: Smoking in patients with diabetes was widespread, especially in young female type 1, and in middle-aged type 1 and type 2 diabetes patients, and should be the target for smoking cessation campaigns. Smoking was associated with both poor glycaemic control and microalbuminuria, independently of other study characteristics.
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