Holm Astrid Ledgaard, Andersen Gregers Stig, Jørgensen Marit E, Diderichsen Finn
Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Clinical Epidemiology Research Group, Steno Diabetes Center Copenhagen, Gentofte, Denmark.
BMJ Open. 2018 Nov 13;8(11):e023211. doi: 10.1136/bmjopen-2018-023211.
The study aimed at analysing whether the 'Rule of Halves' framework applies for diabetes care in the Danish healthcare system with high levels of accessibility and equity. The Rule of Halves states that only one-half of people with a particular chronic condition are diagnosed; one-half of those diagnosed get treatment, and one-half of treated achieve desired therapeutic goals.
The analysis is cross sectional based on available surveys, register data and clinical databases covering the adult population in Copenhagen. We analysed five levels of prevention and care including behavioural risk factors and biomarkers, prevalence of diagnosed and undiagnosed diabetes as well as how many received care according to guidelines and achieved relevant outcomes.
The study population is Copenhagen City with a population of 550 000 with 21 500 prevalent cases of diabetes. While the registers used cover the whole population, the surveys include 750 cases and the biobank data 365 cases.
Outcome measures are for each level of analysis: the prevalence of high-risk individuals, prevalence of undiagnosed and diagnosed diabetes, proportion receiving treatment and proportion achieving quality and treatment targets.
We found that the 'Rule of Halves' framework raises relevant questions on how diabetes care works in a specific population, but the actual proportions found in Copenhagen are far from halves. Our analyses showed that 74% are diagnosed and among those who are 90% are receiving care. 40%-60% have achieved target levels of treatment in terms of HbA1c level and lipid levels. 80% have received eye and foot examinations in the last 2 years. 11% have retinopathy and 25% have macrovascular complications.
Copenhagen is doing much better than halves, when it comes to diagnosis and providing treatment, whereas the Rule of Halves still prevails when it comes to treatment targets. There is thus still room for improvement.
本研究旨在分析“一半法则”框架是否适用于丹麦医疗体系中具有高可及性和公平性的糖尿病护理。一半法则指出，只有一半患有特定慢性病的人会被诊断出来；被诊断出的患者中有一半会接受治疗，而接受治疗的患者中有一半能实现预期治疗目标。
该分析基于现有的调查、登记数据和临床数据库进行横断面研究，涵盖哥本哈根的成年人口。我们分析了五个预防和护理层面，包括行为风险因素和生物标志物、已诊断和未诊断糖尿病的患病率，以及有多少人根据指南接受了护理并取得了相关结果。
研究人群为哥本哈根市，人口55万，有21500例糖尿病患者。虽然所使用的登记数据涵盖了整个人口，但调查包括750例病例，生物样本库数据包括365例病例。
每个分析层面的观察指标包括：高危个体的患病率、未诊断和已诊断糖尿病的患病率、接受治疗的比例以及实现质量和治疗目标的比例。
我们发现，“一半法则”框架就糖尿病护理在特定人群中的运作方式提出了相关问题，但在哥本哈根实际发现的比例远非一半。我们的分析表明，74%的患者被诊断出来，其中90%正在接受治疗。就糖化血红蛋白水平和血脂水平而言，40%-60%的患者达到了治疗目标水平。80%的患者在过去两年中接受了眼部和足部检查。11%的患者患有视网膜病变，25%的患者患有大血管并发症。
在诊断和提供治疗方面，哥本哈根的表现远高于一半法则的水平，而在治疗目标方面，一半法则仍然适用。因此仍有改进空间。
