Glycemic control in patients with diabetes in Finland

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 patients from each center (total n = 3,800). HbA(1c) was used as an index of glycemic 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 whole 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) level in type 1 diabetic patients. However, male type 2 diabetic patients had 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 shortest 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 diabetic patients in Finland, Better treatment strategies and methods should be used to improve glycemic control and to reduce long-term complications.