Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Anneli Sandbæk, AUH - Aarhus University Hospital, Denmark
- Second opponent: Professor Ragnar Joakimsen, UiT - The Arctic University of Norway,
- Third member and chair of the evaluation committee: Associate professor Ingrid Nermoen, University of Oslo
Chair of the Defence
Associate Professor Anne-Marie Aas, University of Oslo
Principal Supervisor
Research Director Signe Flottorp, Norwegian Institute of Public Health
Summary
Type 2 diabetes is a chronic disease that increases the risk of complications such as cardiovascular disease, kidney disease, and blindness. The risk of complications is reduced through multifactorial treatment of risk factors such as elevated blood glucose, cholesterol and blood pressure.
The thesis investigated the management of type 2 diabetes in Norway, encompassing general practice and outpatient clinics. Clinical data of more than 10.000 type 2 diabetes patients were collected from general practitioners’ (GPs’) electronic medical records to form the ROSA 4 study. The objective was to bridge potential gaps in the quality of care by examining various aspects of care.
We aimed to investigate variation in quality of care among general practitioners, the relation between the quality of care and estimated cardiovascular risk of the patients, and patterns of change in average blood glucose (HbA1c) among patients referred to secondary care.
The results revealed a large variation between GPs in their performance of recommended procedures such as testing for risk factors and screening for complications. Which practice the GP worked in played a crucial role in this variation. Structural elements like using follow-up forms and patient reminders positively impacted GPs’ performance. Higher GP workload and higher GP age were associated with poorer performance. Patients treated by GPs with lower adherence to recommended procedures faced higher estimated risk of cardiovascular disease and an increased likelihood of elevated HbA1c levels.
Initiating treatment at a diabetes outpatient clinic notably improved HbA1c levels for patients with severely increased blood glucose levels. We identified three groups with distinct patterns in development of HbA1c. We also identified variation between the diabetes outpatient clinics in the services received by patients.
The study underscores the importance of structural factors and practice routines in achieving a higher treatment quality.
Additional information
Contact the research support staff.