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Effects on HbA1c of referral of type 2 diabetes patients to secondary care.

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Title: Effects on HbA1c of referral of type 2 diabetes patients to secondary care.
Authors: Nøkleby, Kjersti (AUTHOR), Jenum, Anne K. (AUTHOR), Buhl, Esben Selmer (AUTHOR), Claudi, Tor (AUTHOR), Cooper, John G. (AUTHOR), Flottorp, Signe (AUTHOR), Løvaas, Karianne F. (AUTHOR), Sandberg, Sverre (AUTHOR), Berg, Tore Julsrud (AUTHOR)
Source: Scandinavian Journal of Primary Health Care. Jun2025, Vol. 43 Issue 2, p313-323. 11p.
Subjects: Outpatient services in hospitals, Glycosylated hemoglobin, Research funding, Kruskal-Wallis Test, Fisher exact test, Descriptive statistics, Chi-squared test, Type 2 diabetes, Analysis of variance, Data analysis software, Confidence intervals, Medical referrals
Abstract: Aim: To study trajectories of HbA1c in type 2 diabetes (T2D) patients referred to diabetes outpatient clinics (DOCs), and to explore characteristics of referrals and patient pathways in patients treated in DOCs. Methods: We retrospectively followed T2D patients from the Norwegian population-based ROSA 4 study to identify persons with T2D who were referred to a DOC. We used latent class trajectory modelling to identify subgroups of patients with similar patterns of HbA1c one year before to one year after the first consultation at a DOC. We performed multinomial regression analyses to identify baseline characteristics associated with group membership. Results: Four hundred and two of 6716 T2D patients started treatment at a DOC, constituting a yearly starting rate of 1.5%. We identified three classes of HbA1c trajectories: (1) stable moderate hyperglycaemia (75%); (2) severe hyperglycaemia with a decline in HbA1c around referral (14%) and (3) severe hyperglycaemia with a decline in HbA1c after starting treatment at the DOC (11%). HbA1c trajectories were associated with diabetes duration RRR 0.92, CI (0.87, 0.97) in class 2 vs. 1 and 0.93 (0.88, 0.98) in class 3 vs. 1. Some differences were found between clinics in rejection rate, processes of care, and duration of follow-up. Conclusions: Norwegian GPs handle most T2D patients themselves. Those with T2D and severe hyperglycaemia had a considerable benefit from being referred to a DOC, though with two separate trajectories: One where HbA1c improved around the time of referral, and another that improved after starting in a DOC. Key Points: The data originate from a high-quality database of type 2 diabetes patients. The strength of the data-driven latent class trajectory modelling (LCTM) is that it can uncover hidden patterns of HbA1c changes in heterogenic populations. On the other hand, LCTM have concerns about generalisability, as it may be difficult to replicate. Among other limitations are a rather small number of patients referred during the study years, increasing the risk of type 2 errors in further analyses. [ABSTRACT FROM AUTHOR]
Copyright of Scandinavian Journal of Primary Health Care is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Effects on HbA1c of referral of type 2 diabetes patients to secondary care.
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  Data: <searchLink fieldCode="AR" term="%22Nøkleby%2C+Kjersti%22">Nøkleby, Kjersti</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Jenum%2C+Anne+K%2E%22">Jenum, Anne K.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Buhl%2C+Esben+Selmer%22">Buhl, Esben Selmer</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Claudi%2C+Tor%22">Claudi, Tor</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Cooper%2C+John+G%2E%22">Cooper, John G.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Flottorp%2C+Signe%22">Flottorp, Signe</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Løvaas%2C+Karianne+F%2E%22">Løvaas, Karianne F.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Sandberg%2C+Sverre%22">Sandberg, Sverre</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Berg%2C+Tore+Julsrud%22">Berg, Tore Julsrud</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Scandinavian+Journal+of+Primary+Health+Care%22">Scandinavian Journal of Primary Health Care</searchLink>. Jun2025, Vol. 43 Issue 2, p313-323. 11p.
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  Data: <searchLink fieldCode="DE" term="%22Outpatient+services+in+hospitals%22">Outpatient services in hospitals</searchLink><br /><searchLink fieldCode="DE" term="%22Glycosylated+hemoglobin%22">Glycosylated hemoglobin</searchLink><br /><searchLink fieldCode="DE" term="%22Research+funding%22">Research funding</searchLink><br /><searchLink fieldCode="DE" term="%22Kruskal-Wallis+Test%22">Kruskal-Wallis Test</searchLink><br /><searchLink fieldCode="DE" term="%22Fisher+exact+test%22">Fisher exact test</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Chi-squared+test%22">Chi-squared test</searchLink><br /><searchLink fieldCode="DE" term="%22Type+2+diabetes%22">Type 2 diabetes</searchLink><br /><searchLink fieldCode="DE" term="%22Analysis+of+variance%22">Analysis of variance</searchLink><br /><searchLink fieldCode="DE" term="%22Data+analysis+software%22">Data analysis software</searchLink><br /><searchLink fieldCode="DE" term="%22Confidence+intervals%22">Confidence intervals</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+referrals%22">Medical referrals</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Aim: To study trajectories of HbA1c in type 2 diabetes (T2D) patients referred to diabetes outpatient clinics (DOCs), and to explore characteristics of referrals and patient pathways in patients treated in DOCs. Methods: We retrospectively followed T2D patients from the Norwegian population-based ROSA 4 study to identify persons with T2D who were referred to a DOC. We used latent class trajectory modelling to identify subgroups of patients with similar patterns of HbA1c one year before to one year after the first consultation at a DOC. We performed multinomial regression analyses to identify baseline characteristics associated with group membership. Results: Four hundred and two of 6716 T2D patients started treatment at a DOC, constituting a yearly starting rate of 1.5%. We identified three classes of HbA1c trajectories: (1) stable moderate hyperglycaemia (75%); (2) severe hyperglycaemia with a decline in HbA1c around referral (14%) and (3) severe hyperglycaemia with a decline in HbA1c after starting treatment at the DOC (11%). HbA1c trajectories were associated with diabetes duration RRR 0.92, CI (0.87, 0.97) in class 2 vs. 1 and 0.93 (0.88, 0.98) in class 3 vs. 1. Some differences were found between clinics in rejection rate, processes of care, and duration of follow-up. Conclusions: Norwegian GPs handle most T2D patients themselves. Those with T2D and severe hyperglycaemia had a considerable benefit from being referred to a DOC, though with two separate trajectories: One where HbA1c improved around the time of referral, and another that improved after starting in a DOC. Key Points: The data originate from a high-quality database of type 2 diabetes patients. The strength of the data-driven latent class trajectory modelling (LCTM) is that it can uncover hidden patterns of HbA1c changes in heterogenic populations. On the other hand, LCTM have concerns about generalisability, as it may be difficult to replicate. Among other limitations are a rather small number of patients referred during the study years, increasing the risk of type 2 errors in further analyses. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Scandinavian Journal of Primary Health Care is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/02813432.2024.2433107
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 11
        StartPage: 313
    Subjects:
      – SubjectFull: Outpatient services in hospitals
        Type: general
      – SubjectFull: Glycosylated hemoglobin
        Type: general
      – SubjectFull: Research funding
        Type: general
      – SubjectFull: Kruskal-Wallis Test
        Type: general
      – SubjectFull: Fisher exact test
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      – SubjectFull: Descriptive statistics
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      – SubjectFull: Chi-squared test
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      – SubjectFull: Type 2 diabetes
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      – SubjectFull: Analysis of variance
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      – SubjectFull: Data analysis software
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      – SubjectFull: Confidence intervals
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      – SubjectFull: Medical referrals
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      – TitleFull: Effects on HbA1c of referral of type 2 diabetes patients to secondary care.
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              M: 06
              Text: Jun2025
              Type: published
              Y: 2025
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