Quality of diabetes care in Italy: Information from a large population-based multiregional observatory (ARNO diabetes)

A marked variability has been documented in the therapeutic approaches to diabetes by various countries, suggesting that the level of care currently delivered may not produce the expected health-related gains. We investigated quality of care indicators in a large, representative multiregional population-based cohort of people (the ARNO Observatory) living in four Italian regions (2 million inhabitants), assessing process indicators and hospital admissions as outcome indicators. Diabetic individuals were identified in 2010 through record linkage among prescriptions, hospital admissions, and local diabetes registries. The guidelines of the Italian scientific societies recommend that risk factors such as lipids and microalbuminuria should be tested at least once a year in all patients with type 2 diabetes, and HbA1c should be tested at least twice a year, even in people with stable glycemic control over time and more frequently in insulin-treated and -complicated people. Of 126,163 diabetic individuals (prevalence of diabetes 5.8%, mean age 71 years), as many as 42% did not have their HbA1c measured for over a year. Even considering only insulin-treated people, this frequency remains disappointingly high (35%). The proportion of people having at least two annual tests for HbA1c was low (32.7%; 43.1% among insulin-treated patients).