OBJECTIVE - To evaluate the quality of diabetes care at a national level in
Finland, using level of glycemia as a determinant of success in treatment.
RESEARCH DESIGN AND METHODS - Physicians and diabetes nurses in 76 randomly
selected clinics (59 primary care units and 17 hospitals) evenly covering
the whole of Finland were asked to fill in a questionnaire asking for data
based on the 1993 medical records of a random sample of 50 diabetic patient
s from each center (total n = 3,800). HbA(1c) was used as an index of glyce
mic control.
RESULTS - Information on 3,195 (84%) diabetic patients was received. HbA(1c
) was measured in 67% of the patients in 1993. The mean HbA(1c) in the whol
e population was 8.6 +/- 1.9% (normal range 4-6%). Some 25% of patients had
HbA(1c) less than or equal to 7.3%, while 25% had HbA(1c) greater than or
equal to 9.7%. The mean HbA(1c) was 8.8 +/- 1.9% in type 1 and 8.5 +/- 1.9%
in type 2 diabetic patients. There was no sell difference in the HbA(1c) l
evel in type 1 diabetic patients. However, male type 2 diabetic patients ha
d better glycemic control than female patients (8.3 +/- 1.9 vs. 8.8 +/- 1.9
%, P < 0.0001). The sex difference was independent of the type of therapy.
The mean level of glycemic control was lowest among individuals with the sh
ortest duration of diabetes. After 7-9 years after the diagnosis, there was
no change in the mean level of glycemia.
CONCLUSIONS - Average glycemic control is poor in a majority of the diabeti
c patients in Finland, Better treatment strategies and methods should be us
ed to improve glycemic control and to reduce long-term complications.