AMD Annals 2020 - Synopsis on Type 2 Diabetes. Evaluation of AMD quality indicators of type 2 diabetes care in Italy

Abstract

OBJECTIVE OF THE STUDY The AMD 2020 Annals on Type 2 Diabetes (DM2) set out to show, 2 years after the last evaluation, how the quality of DM2 care has evolved in Italy. DESIGN AND METHODS In order to participate in the initiative, the centers had to be equipped with information systems capable of guaranteeing the standardized extraction of the information necessary for the creation of the AMD Data File. The data analyzed concern socio-de-mographic and clinical characteristics and volume of activity. The selection of indicators is based on Revision 8 of June 2019 (AMD Annals website). RESULTS DM2 patients increased to 473,740 (57.1% M; 42.9% F, 67.4% aged> 65 y). 6% new diagnoses. All monitoring indicators, of favorable and unfavorable outcome, have improved: 52.9% of DM2 have HbA1c levels <= 7.0%(53 mmol/mol), 63.5% have LDL cholesterol values <100 mg / dl, 53,5% have blood pressure levels <140/80 mmHg, 39.9% are obese. The proportion of patients with GFR <60 mL/min*1.73 m2 rose to 29%, and 7.1% had GFR <30 mL / min. Therapy: there is a reduction in the use of sulfonylureas and glinides (19.9%); stable use of insulin; new drugs are increasingly prescribed (DPPIVi:21%; GLP1-RA: 5.9%; SGLT2i: 9.6%). 60.8% are on lipid-lowering treatment, 70% are on antihypertensive therapy, but 48.6% are not on target. Complications: 22% have diabetic retinopathy; 7.5% had myocardial infarction, 2.7 had a stroke, 14.7% had a history of cardiovascular disease. 50.8% of subjects with age>75a have HbA1c levels <= 7.0%(53 mmol/mol), of these 16.3% are treated with drugs that can induce hypoglycemia. Patients with Q Score> 25 are growing (60.3%). CONCLUSIONS The AMD 2020 Annals on DM2 show a marked improvement in all indicators of quality of care, but large areas of undertreatment and other overtreatment remain, and call to action. KEY WORDS AMD Annals; type2 diabetes mellitus; quality of diabetes care in type 2 diabetes patients in Italy; undertreatment; overtreatment.