Among chronic diseases, diabetes is a frequent focus of performance measurement. Disease-specific indicators based on evidence-based clinical guidelines have been used to evaluate the quality of care. There are worldwide efforts to improve the quality of diabetes care. Measuring the gap is an essential first step toward improving the quality of care.
In order to better understand the status of quality of diabetes care in Japan, a country with a universal healthcare system, we performed a literature search looking for all studies reporting on quality indicators. In this review, we summarized the studies that have looked at the status of the quality of diabetes care over the last decade.
There were a total of 6 studies that reported on process including HbA1c, blood pressure, lipid screening, retinopathy and nephropathy screening and intermediate clinical measures which included percentages of patients reaching targets for HbA1c, blood pressure and LDL-C. Overall, the process measures continue to improve, however the clinical intermediate outcome measures remain suboptimal.
Despite the improvement in diabetes related process measures, there is limited data on clinical measures. It is necessary to shed more light on the assessment of the quality of diabetes care.
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Ali MK, Bullard KM, Gregg EW. Achievement of goals in U.S. Diabetes Care, 1999–2010. N Engl J Med. 2013;18:369(3):287–8.
International Diabetes Federation Guideline Development G. Global guideline for type 2 diabetes. Diabetes Res Clin Pract. 2014;104(1):1–52.
Introduction: <em>Standards of medical care in diabetes—2020</em>. Diabetes Care. 2020;43(Supplement 1):S1-S2.
Araki E, Goto A, Kondo T, et al. Japanese clinical practice guideline for diabetes 2019. Diabetol Int. 2020;11(3):165–223.
International Diabetes Federation. Available at https://idf.org/our-network/regions-members/western-pacific/members/105-japan.html. Accessed on September 3rd, 2020.
Ministry of Health, Labour and Welfare. National Health and Nutrition Survey. Available at https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/kenkou_iryou/kenkou/eiyou/h30-houkoku_00001.html. [in Japanese] [accessed on July 16th, 2020].
International Diabetes Federation. Available at https://diabetesatlas.org/upload/resources/material/20200302_133351_IDFATLAS9e-final-web.pdf. Accessed on September 3rd, 2020.
Rivera-Hernandez M, Leyva B, Keohane LM, et al. Quality of care for white and hispanic medicare advantage enrollees in the united states and puerto rico. JAMA Intern Med. 2016;176(6):787–94.
Stone MA, Charpentier G, Doggen K, et al. Quality of care of people with type 2 diabetes in eight European countries: findings from the guideline adherence to enhance care (GUIDANCE) study. Diabetes Care. 2013;36(9):2628–38.
Du Y, Heidemann C, Schaffrath Rosario A, et al. Changes in diabetes care indicators: findings from German National Health Interview and Examination Surveys 1997–1999 and 2008–2011. BMJ Open Diabetes Res Care. 2015;3(1):e000135.
Ikegami N, Yoo BK, Hashimoto H, et al. Japanese universal health coverage: evolution, achievements, and challenges. Lancet. 2011;378(9796):1106–15.
Haneda M, Noda M, Origasa H, et al. Japanese Clinical Practice Guideline for Diabetes 2016. J Diabetes Investig. 2018.
American Diabetes A. 6. Glycemic Targets: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S66–S76.
National Heart and Lung Institute. Available at https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools. Accessed on September 3rd, 2020
Tomio J, Toyokawa S, Tanihara S, et al. Quality of care for diabetes patients using National Health Insurance claims data in Japan. J Eval Clin Pract. 2010;16(6):1164–9.
Tanaka H, Tomio J, Sugiyama T, et al. Process quality of diabetes care under favorable access to healthcare: a 2-year longitudinal study using claims data in Japan. BMJ Open Diabetes Res Care. 2016;4(1):e000291.
Yokoyama H, Oishi M, Takamura H, et al. Large-scale survey of rates of achieving targets for blood glucose, blood pressure, and lipids and prevalence of complications in type 2 diabetes (JDDM 40). BMJ Open Diabetes Res Care. 2016;4(1):e000294.
Tanaka H, Sugiyama T, Ihana-Sugiyama N, et al. Changes in the quality of diabetes care in Japan between 2007 and 2015: A repeated cross-sectional study using claims data. Diabetes Res Clin Pract. 2019;149:188–99.
Sugiyama T, Imai K, Ihana-Sugiyama N, et al. Variation in process quality measures of diabetes care by region and institution in Japan during 2015–2016: An observational study of nationwide claims data. Diabetes Res Clin Pract. 2019;155:107750.
Ozaki M, Matsumura S, Iwamoto M, et al. Quality of primary care provided in community clinics in Japan. J Gen Fam Med. 2019;20(2):48–54.
Funatsu H, Hori S, Shimizu E, et al. Questionnaire survey on periodic ocular examination in Japanese diabetic patients. Am J Ophthalmol. 2003;136(5):955–7.
Hidaka H, Terada M, Maegawa H, et al. Evaluation of a new care system provided to diabetic patients in the outpatient clinic. Intern Med. 2000;39(10):783–7.
Andary R, Fan W, Wong ND. Control of cardiovascular risk factors among US adults with type 2 diabetes with and without cardiovascular disease. Am J Cardiol. 2019;124(4):522–7.
Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457–502.
Hayashino Y, Suzuki H, Yamazaki K, et al. A cluster randomized trial on the effect of a multifaceted intervention improved the technical quality of diabetes care by primary care physicians: The Japan Diabetes Outcome Intervention Trial-2 (J-DOIT2). Diabet Med. 2016;33(5):599–608.
Idler EL, Benyamini Y. Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav. 1997;38(1):21–37.
Kleefstra N, Landman GW, Houweling ST, et al. Prediction of mortality in type 2 diabetes from health-related quality of life (ZODIAC-4). Diabetes Care. 2008;31(5):932–3.
Schmitt A, Reimer A, Kulzer B, et al. Assessment of diabetes acceptance can help identify patients with ineffective diabetes self-care and poor diabetes control. Diabet Med. 2014;31(11):1446–51.
Schmitt A, Reimer A, Kulzer B, et al. Negative association between depression and diabetes control only when accompanied by diabetes-specific distress. J Behav Med. 2015;38(3):556–64.
Hayashino Y, Okamura S, Tsujii S, et al. Association between diabetes distress and all-cause mortality in Japanese individuals with type 2 diabetes: a prospective cohort study (Diabetes Distress and Care Registry in Tenri [DDCRT 18]). Diabetologia. 2018 2018/09/01;61(9):1978–1984.
Hayashino Y, Okamura S, Tsujii S, et al. Predictive Validity of Each Item of the 8-Item Short-Form Health Survey for All-Cause Mortality in Japanese patients with type 2 diabetes: A prospective Cohort Study (Diabetes Distress and Care Registry at Tenri [DDCRT 19]). Exp Clin Endocrinol Diabetes. 2019.
Asia Pacific Observatory on Health Systems and Policies.vol. 8(1) (2018). Available at http://www.searo.who.int/entity/asia_pacific_observatory/publications/hits/hit_japan/en/. Accessed 17 July 2019.
Eggleston K, Chen BK, Chen C-H, et al. Are quality-adjusted medical prices declining for chronic disease? Evidence from diabetes care in four health systems. Eurpean J Health Econom. 2020 2020/07/01;21(5):689–702.
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Conflict of interest
Authors Takehiro Sugiyama, Hirokazu Tanaka, Mitsuru Ohsugi and Robert Gabbay declare they have no conflict of interest. The authors declare no potential conflict of interest. Author Joanna Mitri received honoraria for consulting for Novo Nordisk and Dairy Farmers, and receives research support from the National Dairy Council, KOWA, Inc., the NIH and the JDRF.
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Mitri, J., Sugiyama, T., Tanaka, H. et al. Understanding the quality of diabetes care in Japan: a systematic review of the literature. Diabetol Int (2021). https://doi.org/10.1007/s13340-021-00497-3
- Guideline adherence
- Diabetes care
- Quality assessment
- Quality indicators