The Diabetes Register of Belgium · Noëmi Debacker Scientific Institute of Public Health Special BIRO Academy Meeting “Coordinated Information Delivery from Diabetes Registers

EUropean Best Information through Regional Outcomes in Diabetes

Materials, Methods and Data Analysis of Diabetes Registers

The Diabetes Register of Belgium Noëmi Debacker

Scientific Institute of Public Health

Special BIRO Academy Meeting“Coordinated Information Delivery from Diabetes Registers

to improve quality and outcomes in Europe”Rome 4-5th June 2010

BelgiumReference Population

MAP

Country: BelgiumRegion: Entire countryTotal Population: 10,666,866 (2008)Diabetes Prevalence: 3.5% (2008 HIS)Type of Data Sources: Patient medical record – data obtained for quality assurance purposes

N.Participating Centres: 120 (2007)=> Secondary care diabetes centres (hospital based)

Put your map here

Belgium Local Database Structure

Centre 1: Medical patient

record

IPH:Data

management & analysis


record

Centre n: Medical patient

record

National secondary care dataset: Demographic

and clinical data (similar to DiabCare)

Feedback

Cycle: every 18 months

Belgium Local Database Structure: IT

• Location: server of the IPH• Centres and patients are

anonymous• Declaration towards the commission

for the protection of privacy and ethical committee

• User access management• Security policy of the IPH• Protection of infrastructure• Logical protection• Network protection

2001

Per year of data collection

=> Spreadsheet

20022004

20062007

2009

Belgium Local Database Structure and the BIRO Merge Table

BIROMerge Table

National secondary care dataset: Demographic

and clinical data (similar to DiabCare)


record

IPH:Data

management & analysis


record

Centre n: Medical patient

record

• Demographical data• Type of diabetes and year of diagnosis• Hypoglycaemic and additional treatment• Cardiovascular risk• Process of care (eg. Screening of complications)• Presence of micro- and macrovascular complications

Belgium Using BIRO

Strengths• Very nice and patient people helping you out• In the end the programme is quite logical to use• If it works it can offer a “quick” and “correct”

snapshot of local results Problems/weaknesses• Up to now: mainly technical problems in the

making of the local report => time consuming • Its use and possibilities require an explanation

Belgium Mapping to BIRO European Standard

• The mapping needs a thorough preparation/knowledge of the source database => written and correct document such as the BIRO Common Dataset is necessary

• BIRO field description: difficult to read in the BIRObox

• Time consuming the first time• Data in data source configuration: difficult to obtain

(sometimes rough estimation), originates from different years: to what extent are these taken into account?

Belgium Merge Table Contents

End Stage Renal TherapyRenal Dialysis

Renal TransplantStroke

Active Foot UlcerMyocardial Infarction

LaserHypertension

BlindnessAmputation

Antihypertensive MedicationHypoglycemic Drug Therapy

Oral Drug TherapyPump Therapy

Total CholesterolHDLTriglyceridesEye ExaminationRetinopathy StatusMaculopathy StatusFoot ExaminationFoot PulsesFoot SensationNasal TherapyAverage InjectionsSelf MonitoringDiabetes Specific EducationLipid Lowering TherapyAnti-platelet TherapyPatient Enrolment in DMP

Patient IDData Source IDType Of DiabetesSexMonth & Year of BirthYear of DiagnosisEpisode DateSmoking StatusCigarettes per dayAlcohol IntakeWeightHeightBody Mass IndexSystolic Blood PressureDiastolic Blood PressureHbA1cCreatinineMicroalbumin

Belgium Additional Data

Activity Table:Not available

Population Table: Available: data from 2007

Diabetic Population Table:Available from Health Interview Survey 2008:

Validity? No data by type of diabetes

Belgium Running BIRO: Data Quality Results

• Results of the obtained BIRO report were verified:=> The largest part of the results were correct=> Those not correct were reported to BIRO:– Inverse presentation of complications– Missing values treated as absence of complications– Some slight difference in absolute numbers: reason?– Strange presentation of percentages (foot examination &

age)– Some wrong results (process smoking status)=> For some of the results, the calculation behind was not

understood/calculations were not appropriate for the type of data we have

– Life expectancy– Visit frequency– Prevalence of DM

Belgium Statistical Report

Belgium Statistical Report: General Characteristics

• Type of diabetes & age

• Duration of diabetesType 1 diabetes Type 2 diabetes

Male Female Total Male Female Total

0-9 yrs 614 (32%) 418 (28%) 30% 1243 (37%) 1166 (33%) 35%

10-19 yrs 565 (29%) 444 (29%) 29% 1368 (41%) 1391 (39%) 40%

20+ yrs 737 (38%) 654 (43%) 41% 762 (23%) 965 (27%) 25%

19-34

Belgium Statistical Results: BIRO Indicators (1)

Hypoglycaemic treatment:100% treated with insulin (problem with

results: missing values are counted as « not insulin treated »)

Additional oral treatment: 50% DM2 and 8% DM1 (identical problem)

Selfmonitoring100%


Prevalence of diabetes complications• ESRF: 3.7%• Foot ulcer: 8.5%• Amputation: 4.3%• Stroke: 10.4%• MI: 11.6%


<7%7-7.9%≥ 8%


• BMI<25 kg/m²: 47% (DM1) - 12% (DM2)• BMI increases with age until age 75 in DM1• Obesity prevalence decreases with age in

DM2• BMI by gender


Smokers: 21% (DM1) - 12%(DM2); 11% ♀ - 19% ♂

By age


BP<140/90 mmHg: 71% (DM1) – 52% (DM2)By age


Total cholesterol


HDL-cholesterol


Microalbuminuria

NormalAbnormal


Process of care• Foot examination/12 mo : 90%• Eye examination/12 mo : 76%• ≥ 1 BP measurement/12 mo: 99%• ≥ 1 lipid measurement/12mo: 96%• µalb measurement/12 mo: 79%• ≥ 1 HbA1c measurement/12mo: 99%

Belgium Conclusions (1): Statistical Results

• Intensively treated diabetes population with large diabetes duration and high age

• Prevalence of complications is considerable• Quality of care is good in terms of process

indicators (less good results for the eye and kidney examination)

• Quality of care is good in terms of outcome indicators and comparable to other health care settings

• Room for improvement remains• Data is NOT representative for entire Belgian

diabetes population!

Belgium Conclusions (2):BIRO usage

• I believe that once the system works, the immediate local feedback could be an important tool for the evaluation of quality of diabetes care, however:– Up to now: time consuming– Results in report need to be verified– Need for consequent treatment of missing values– Up to now structure of the report does not seem entirely

logical– Minimal knowledge of data management is required– Some parts of the report do not apply for all kinds of

databases

BelgiumFuture LOCAL Perspectives

• No large changes are foreseen with regard to IQED (actual data used for BIRO) – most fields map well to the BIRO as they actually are

• Additional dataMost data originate from QA projects

We do not have data on all patients of a certain region

– Additional data on paediatric type 1 diabetes can become available

– Maybe additional primary care data will become available

Belgium Future BIRO Perspectives

• Although the result in the end is very nice (but not entirely finished):– Plenty of intermediate steps to reach the result

which seem “source database” specific <--> magic box?

– The structure and methodology of the report might need some reconsideration

Belgium

Thanks for the attention!


Antihypertensive treatment:


Antiplatelets:


Lipid lowering treatment:

Documents

The Diabetes Register of Belgium · Noëmi Debacker Scientific Institute of Public Health Special BIRO Academy Meeting “Coordinated Information Delivery from Diabetes Registers