Original articleTrends in the quality of care for elderly people with type 2 diabetes: The need for improvements in safety and quality (the 2001 and 2007 ENTRED Surveys)Évolution de 2001 à 2007 de la qualité des soins reçue par les personnes âgées atteintes de diabète de type 2 (études Entred) : renforcer sécurité et qualité
Introduction
The World Health Organization (WHO) predicts an epidemic of diabetes in most countries linked to both changes in lifestyle and ageing of the population [1]. In France, the prevalence of diabetes was estimated at 4.4% in 2009 based on pharmaceutical treatments. The prevalence increased with age to 14.2% in those aged 65–74 years, peaking at 19.7% in men and 14.2% in women aged 75–79 years [2]. More than half of those with diabetes were aged 65 years or above, corresponding to at least one million people in France [3]. From 2001 to 2005, the prevalence of diabetes increased by 3.1 points in men aged 70–79 years and 3.8 points in men aged 80–89 years, and by 0.7 points and 3.0 points, respectively, in women in those age groups [4].
Elderly patients with diabetes are at increased risk of diabetes complications, loss of cognitive function and mobility and, consequently, of dependency [5]. The increasing number of older individuals with diabetes will, therefore, lead to a greater public health burden [6], [7]. Adequate management and active monitoring of this population with comprehensive gerontological assessment may reduce this growing burden [8].
Cross-sectional surveys of adults (all ages) with diabetes (the Échantillon national témoin représentatif des personnes diabétiques, or Entred, surveys) were performed in France in 2001 and 2007 to monitor the health status of patients with diabetes. Results have been published for all age ranges elsewhere [9]. The present analysis used the 2001 and 2007 French surveys, and focused on the growing population of elderly people (≥ 65 years old) with type 2 diabetes, whose status is often already frail, to assess 6-year trends in sociodemographic characteristics, risk factors, diabetes complications and quality of care.
Section snippets
Population
The 2007 Entred source population included all adults who claimed reimbursements for at least three oral hypoglycaemic agents (OHAs) or insulin between August 2006 and July 2007 from the two major French health insurance systems—Caisse nationale d’assurance maladie des travailleurs salariés (CNAMTS, which covers 70% of the population of France) and Régime des salariés indépendants (RSI, covering 5% of the population)—which together cover all active and retired employees or self-employed workers
Participants in the 2001 and 2007 Entred surveys, all ages and diabetes types
Response rates to both the PQ and CPQ increased significantly between 2001 and 2007 (PQ: 44% in 2007; +11 points since 2001; CPQ: 56%; +9 points since 2001) (Table 1). Compared with non-responders, responders to the 2007 PQ were younger, more likely to be male and benefited more often from a waiver of co-payment due to diabetes or another chronic disease. Overall, both PQ responders and patients whose care providers responded to the CPQ were more likely to receive better care than
Discussion
The present analysis documented substantial decreases in mean HbA1c, BP and LDLc in elderly people with diabetes over 6 years, while the use of medication sharply increased. However, although the aim of such medication is to stop or delay the appearance of diabetes complications, there was also an increase in the prevalence of complications, insufficient screening for most complications and an increasing risk of side effects.
Conclusion
The quality of care delivered to elderly people with type 2 diabetes has dramatically increased since 2001, and their cardiovascular risk profile has improved significantly, which may improve their life expectancy and perhaps their quality of life. Specific improvements, however, are still required, such as better screening and treatment for diabetes complications, especially with regard to eyesight, podiatric risk and renal function, even in the elderly with a recent diabetes diagnosis. Some
Disclosure of interest
E. Eschwège has received consultant’ fees from Astra-Zeneca, GlaxoSmithKline, Novartis, Novo Nordisk, Sanofi Aventis, Merck-Lipha, Mayoly-Spingler.
I. Bourdel-Marchasson: support of teaching book: Novartis, Roche diagnostic, Servier Laboratories; and speaker's bureau and teaching engagement: Novo Nordisk.
P. Lecomte: support of teaching book: Novartis, Roche diagnostic, Servier Laboratories.
A. Fagot-Campagna received an honorarium in 2009 and 2010 from Servier to give a lecture on a course on the
Acknowledgments
We thank all of the patients with diabetes and all of their care providers who participated in this study. The 2007 study was financially supported by the Institut de veille sanitaire as part of its public health missions, Institut national de la prévention et de l’éducation pour la santé, Régime général de l’assurance maladie, Régime des salariés indépendants and Haute Autorité de santé.
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