Understanding the quality of diabetes care in Japan: a systematic review of the literature



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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JM designed the study, performed the literature search, collected and analyzed the data and drafted the initial manuscript. TS, HT, MO and RAG critically reviewed the work and provided substantial comments. All the authors approved the final version of the manuscript.

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Correspondence to Joanna Mitri.

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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

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  • Guideline adherence
  • Diabetes care
  • Quality assessment
  • Quality indicators
  • Japan