How does GIANTT research benefits my own practice or patient population?
Clinical trials, mostly performed in specialist secondary care centra, indicate that intensive diabetes treatment can result in significant health gains. Yet, it is unclear whether these positive results are reflected in your own practice. Only a small fraction of the usually very homogeneous trial population will be a patient you will regularly see. In “real-life” your population is much more heterogeneous (e.g. more comorbidities, non-adherence, polypharmacy, different lab values etc), all requiring a more personalized approach. GIANTT provides evidence for these more personalized treatments of primary care patients.
A selection of recent GIANTT research
- Undertreatment of blood pressure in diabetes type 2 significantly decreased in Groningen
Research of (former) PhD student Sieta de Vries showed that after the introduction of educational courses and quality indicators in Groningen (2008), the undertreatment of blood pressure in patients with type 2 diabetes and systolic blood pressure of ≥140 mmHg has sigfinicantly decreased after 3 years (van 61% naar 51%). Absolutely, this does not seem like a large difference, however at the same time, against all expectations, no increase in overtreatment was noticed. this remained stable at only 16%. This study has been published in the leading diabetes journal Diabetes Care.
- The prescription of statins in diabetes type 2: How is Groningen performing?
PhD student Dianna de Vries’ study revealed that 80% of the Groningen diabetes type 2 patients receives the recommended statin dose. The remaining part received a lower dose. At a lower dose, twice as often dose adjustments were made, non-adherence rates were higher and LDL-cholesterol references values were less often reached. Notably, disregarding the dose, a quarter of patients discontinued statins within the first half year. These results show that Groningen seems to perform relatively well, despite some room for improvement. The study stresses the need for an optimal initial choice of the statin dose as well as the need for active monitroing of medication adherence. The study has recently been published in the International Journal of Clinical Practice.
- Insulin use associated with higher mortality???
An ongoing study, led by post-doctoral researcher dr. Grigory Sidorenkov, looks into differences in response and mortality after initiation of insulin in patients with diabetes type 2. A previous study from Hoorn (The Netherlands) suggested that some patients have a rapid HbA1c decline, associated with increased mortality. Using GIANTT data it is investigated whetehr these results can be confirmed in our population and if so, to provide concrete guidance for a more personalized and safe prescription of insuline in primary care patients with diabetes type 2.