<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03283774</url>
  </required_header>
  <id_info>
    <org_study_id>GOL-DML-2015-01</org_study_id>
    <nct_id>NCT03283774</nct_id>
  </id_info>
  <brief_title>Multifactorial Control of Type 2 Diabetes and Treatment Intensity in Primary Care</brief_title>
  <acronym>eControl</acronym>
  <official_title>Multifactorial Control of Type 2 Diabetes and Treatment Intensity in Primary Care: A Cohort Study</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Fundacio d'Investigacio en Atencio Primaria Jordi Gol i Gurina</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
  </sponsors>
  <source>Fundacio d'Investigacio en Atencio Primaria Jordi Gol i Gurina</source>
  <oversight_info>
    <has_dmc>Yes</has_dmc>
  </oversight_info>
  <brief_summary>
    <textblock>
      Main Objective: To identify changes in metabolic control of type 2 diabetes in patients of&#xD;
      the Catalan national health system during 2007-2013.&#xD;
&#xD;
      Study design: Follow-up of a population with type 2 diabetes during 7 years (2007-2013).&#xD;
&#xD;
      Study participants: Approximately 300,000 people with a clinical record in the SIDIAP&#xD;
      database.&#xD;
&#xD;
      Source: SIDIAP database. Variables and measurements: Age, gender, time since diagnosis of&#xD;
      type 2 diabetes, associated cardiovascular risk factors, micro- and macrovascular&#xD;
      complications of diabetes, causes of mortality, treatment for hyperglycaemia and for&#xD;
      modifiable risk factors, other conditions related to diabetes and its management. The&#xD;
      economic costs of diabetes during the study period will also be analyzed.&#xD;
&#xD;
      Analysis: The clinical variables will be described and 95% confidence intervals will be&#xD;
      calculated for the main variables associated with the study outcomes. Missing values will&#xD;
      count as non-existing data and missing value imputation will not be used in the analysis. If&#xD;
      a subgroup of patients is considered of particular interest, sub analyses will be carried&#xD;
      out. Predictive variables of good metabolic control and of complications and mortality of&#xD;
      diabetes will be analyzed with the hazard ratios for each factor.&#xD;
&#xD;
      Results:&#xD;
&#xD;
      Applicability: The results related to control of diabetes will serve as a basis for improving&#xD;
      metabolic control and decreasing chronic complications and to optimize cost-effectiveness of&#xD;
      treatments.&#xD;
&#xD;
      Significance: A long-term study of a population receiving usual treatment is required to&#xD;
      understand the changes in indicators of metabolic control, morbidity and mortality and in the&#xD;
      management of the disease.&#xD;
&#xD;
      Limitations: Those associated with the use of large population databases.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Main Objective&#xD;
&#xD;
      • To determine the changes in metabolic control of type 2 diabetes during 2007-2013 in&#xD;
      patients of the main Catalan public health provider (Catalan Health Service-CHS).&#xD;
&#xD;
      Secondary Objectives&#xD;
&#xD;
        -  To describe changes in HbA1c values in the Catalan population with type 2 diabetes&#xD;
           during 2007-2013.&#xD;
&#xD;
        -  To describe changes and control of modifiable cardiovascular risk factors (blood&#xD;
           pressure, lipid profile, smoking and obesity) in the Catalan population with type 2&#xD;
           diabetes during 2007-2013.&#xD;
&#xD;
        -  To identify factors associated with changes in HbA1c and in the variables of metabolic&#xD;
           control during the study period.&#xD;
&#xD;
        -  To describe changes in the prevalence of macrovascular (ischemic heart disease,&#xD;
           cerebrovascular accident, peripheral arterial disease) and microvascular complications&#xD;
           (kidney disease, retinopathy) in the Catalan population with type 2 diabetes during&#xD;
           2007-2013.&#xD;
&#xD;
        -  To describe changes in mortality in the Catalan population with type 2 diabetes during&#xD;
           2007-2013.&#xD;
&#xD;
        -  To analyse the main costs of diabetes in Catalonia during 2007-2013.&#xD;
&#xD;
        -  To describe changes in the use of hypoglycaemic agents in the Catalan population with&#xD;
           type 2 diabetes during 2007-2013.&#xD;
&#xD;
        -  To describe changes in the use of medicines to control cardiovascular risk factors&#xD;
           (antihypertensive, hypolipidemic and antiplatelet agents) during 2007-2013.&#xD;
&#xD;
      Hypothesis During 2007-2013 the metabolic control of type 2 diabetes patients in the public&#xD;
      health system of Catalonia (CHS) improves. The management of type 2 diabetes incorporates new&#xD;
      pharmacological treatments.&#xD;
&#xD;
      Methods&#xD;
&#xD;
      Study Design Longitudinal study with cross-sectional, yearly analysis for each year of the&#xD;
      study period (2007-2013).&#xD;
&#xD;
      Reference Population and Study Population A longitudinal study with a cross-sectional yearly&#xD;
      analysis on June 30 of each year (DTALL) in those patients with a verified type 2 diabetes&#xD;
      diagnosis will be carried out with SIDIAP data.&#xD;
&#xD;
      The observation period will be the calendar years 2007 (baseline), 2008, 2009, 2010, 2011,&#xD;
      2012 and 2013 (final).&#xD;
&#xD;
      The SIDIAP database includes the following information of the 5.8 million people from the 282&#xD;
      primary care centres of the Catalan Health Service linked with a unique, anonymized personal&#xD;
      identifier:&#xD;
&#xD;
        1. Information from the electronic clinical records (eCAP): demographic data, visits to the&#xD;
           primary care centre, health conditions (codes ICD-10), clinical variables,&#xD;
           prescriptions, immunizations and referrals.&#xD;
&#xD;
        2. Blood tests results: will be directly retrieved from the laboratories databases.&#xD;
&#xD;
        3. Information on the medication dispensed in pharmacies: obtained from the pharmacy&#xD;
           billing database of the Catalan Health Institute (CatSalut).&#xD;
&#xD;
      Data Collection and Information Sources The data sources are constituted by the electronic&#xD;
      clinical records, blood tests results, the pharmacy register of the SIDIAP database and&#xD;
      mortality data from AQuAS (Health Quality and Evaluation Agency of Catalonia)&#xD;
&#xD;
      Since the study does not target any specific treatment and no specific medication is&#xD;
      considered an exposure therapy under investigation, no definition of exposure to any&#xD;
      medication is included.&#xD;
&#xD;
      Data Analysis&#xD;
&#xD;
      Data analysis will be performed on study patients meeting inclusion criteria. The clinical&#xD;
      variables will be described in terms of absolute and relative frequency for qualitative&#xD;
      variables. Central tendency and dispersion measures will be used to describe quantitative&#xD;
      variables as appropriate and 95% confidence intervals will be calculated for the main&#xD;
      variables associated with the study outcomes.&#xD;
&#xD;
      Statistical tests will be used to compare the distribution of risk factors over time (DTALL):&#xD;
      ANOVA will be used for normally distributed quantitative variables, the non-parametric&#xD;
      equivalent (Kruskal-Wallis) will be used for non-normally distributed variables, and&#xD;
      chi-square test will be used for categorical variables. The P value of the linear trend over&#xD;
      the different time periods will be calculated for each variable. The cost associated with&#xD;
      diabetes will be calculated for each time cohort.&#xD;
&#xD;
      The likelihood-ratio test will be used to test for interaction between the study variables&#xD;
      (eg, HbA1c or cardiovascular events) in nested models with the terms of interaction included&#xD;
      or removed. To analyse changes over time of variables to control diabetes in the study&#xD;
      cohorts from 2007 to 2013, repeated measures ANCOVA and multinomial logistic regression&#xD;
      analysis will be used for quantitative and categorical variables, respectively. These models&#xD;
      will be then be adjusted for potential confounders.&#xD;
&#xD;
      The incidence rate per year will used to analyse the frequency of events during the follow-up&#xD;
      period (eg. ischaemic heart disease, stroke). The Cox proportional hazard model will be&#xD;
      adjusted for potential confounders. Linearity and risk proportionality will be graphically&#xD;
      verified in every model using mean weighted residuals.&#xD;
&#xD;
      Missing values will count as non-existing data and missing value imputation will not be used&#xD;
      in the analysis.&#xD;
&#xD;
      Statistical comparisons will be performed using two-tail hypothesis testing with level of&#xD;
      significance of 0.05. Data management will be conducted by IDIAP Jordi Gol personnel using&#xD;
      the SIDIAP database and data analysis will be conducted by epidemiologists and statisticians.&#xD;
&#xD;
      Study Limitations The main limitations of the study derive from the quality of the register&#xD;
      of big databases. Previous studies with the SIDIAP showed the validity of most of the&#xD;
      variables used in the current protocol.&#xD;
&#xD;
      Ethics&#xD;
&#xD;
      Confidentiality The study will follow the International Guidelines for Ethical Review of&#xD;
      Epidemiological Studies (Council for the International Organizations of Medical Sciences&#xD;
      -CIOMS-, Geneva, 1991), and the Declaration of Helsinki (revision 64th WMA General Assembly,&#xD;
      Fortaleza, Brazil, October 2013).&#xD;
&#xD;
      The management, communication and transfer of data of the participants will comply with the&#xD;
      Protection of Personal Data Organic Law of December 13, 15/1999.&#xD;
&#xD;
      Amendments in the study protocol will be communicated in writing to all investigators and to&#xD;
      the appointed Clinical Research Ethics Committee (CREC) and to the competent authorities&#xD;
      according to the order sas / 3470/2009.&#xD;
&#xD;
      Risk-benefit assessment The current study involves solely access to a database where the data&#xD;
      are anonymized and unlinked. It does not carry therefore any risk for the patients.&#xD;
&#xD;
      Data Confidentiality All information in the SIDIAP database is anonymized and unlinked.&#xD;
&#xD;
      Use of electronic data Data extraction will be carried out from the SIDIAP electronic&#xD;
      database.&#xD;
&#xD;
      Follow-up and final reports A final report with the results obtained will be reviewed and&#xD;
      approved by the IDIAP Jordi Gol researchers. No interim reports are anticipated.&#xD;
&#xD;
      The report should be written following dates in the workplan; a copy of the report will be&#xD;
      sent to the Clinical Research Ethics Committee that has authorised the study.&#xD;
&#xD;
      Conditions of Publication The results of this retrospective, observational study will be&#xD;
      published in international journals with mention of the Clinical Research Ethics Committee&#xD;
      and the sources of funding. None of the investigators will communicate to any third party the&#xD;
      results of the study before final results and interpretation have been agreed.&#xD;
&#xD;
      Clinical Research Ethics Committee (CREC) The IDIAP Jordi Gol CREC will evaluate this study.&#xD;
&#xD;
      Conflict of Interests AstraZENECA will provide funding through a contract with the IDIAP&#xD;
      Jordi Gol Foundation.&#xD;
&#xD;
      AstraZENECA will not interfere in data extraction, analysis and presentation of reports. The&#xD;
      funding is unlinked to the results of the study.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date>January 2015</start_date>
  <completion_date type="Actual">September 2017</completion_date>
  <primary_completion_date type="Actual">April 2015</primary_completion_date>
  <study_type>Observational [Patient Registry]</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <observational_model>Ecologic or Community</observational_model>
    <time_perspective>Prospective</time_perspective>
  </study_design_info>
  <target_duration>7 Years</target_duration>
  <primary_outcome>
    <measure>Diagnosis of the most common cardiovascular risk factors</measure>
    <time_frame>2007-2013</time_frame>
    <description>High Blood Pressure (more then &gt;140/90mm Hg), Dyslipidaemia, Smoking and Obesity</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Level of of glycated haemoglobin (HbA1c)</measure>
    <time_frame>2007-2013</time_frame>
    <description>The value closer and prior to the DTALL date will be considered. A window of up to a year before the DTALL date will be accepted (i.e., from July 1 of the previous year up to DTALL)</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Average of the three last measurements of systolic and diastolic blood pressure</measure>
    <time_frame>2007-2013</time_frame>
    <description>A window of up to a year before the DTALL date will be accepted (i.e., from July 1 of the previous year up to DTALL). If there are no 3 BP measurements, the average of 2 measurements or the value closer and prior to DTALL will be accepted</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Levels of Total Cholesterol (TC), LDL Cholesterol (LDL-C), HDL Cholesterol (HDL-C), triglycerides (TGC) and non-HDL Cholesterol.</measure>
    <time_frame>2007-2013</time_frame>
    <description>A window of up to a year before the DTALL date will be accepted (i.e., from July 1 of the previous year up to DTALL)</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Body Mass Index (BMI)</measure>
    <time_frame>2007-2013</time_frame>
    <description>A window of up to a year before the DTALL date will be accepted (i.e., from July 1 of the previous year up to DTALL). BMI values and calculation of BMI with weight in kg and height in m will be accepted. The height value accepted will be that closer to DTALL measured after 18 years of age. Priority will be given to the calculation with weight in kg and height in m over a BMI value. The date of the calculation of the BMI with the weight and height will determine the weight value</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Kidney function: glomerular filtration estimated by MDRD</measure>
    <time_frame>2007-2013</time_frame>
    <description>The value closer and prior to the DTALL date will be considered. A window of up to a year before the DTALL date will be accepted (i.e., from July 1 of the previous year up to DTALL)</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Kidney function: urinary albumin excretion (albumin/creatinine ratio).</measure>
    <time_frame>2007-2013</time_frame>
    <description>The value closer and prior to the DTALL date will be considered. A window of up to a year before the DTALL date will be accepted (i.e., from July 1 of the previous year up to DTALL)</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Use of hypoglycaemic agents (oral and/or GLP1) and insulin on the DTALL date</measure>
    <time_frame>2007-2013</time_frame>
    <description>Monotherapy and combined therapy with other hypoglycaemic agents will be analysed. Dosage will not be specified. Data of use will be obtained from the pharmacy billing of the Catalan Health Service (CatSalut).</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Use of antihypertensive, hypolipidemic, antiplatelet and anticoagulant agents on the DTALL date</measure>
    <time_frame>2007-2013</time_frame>
    <description>Monotherapy and therapy combined with hypoglycaemic agents will be analysed. Dosage will not be specified.&#xD;
Data of use will be obtained from the pharmacy billing of the Catalan Health Service (CatSalut)</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Cardiovascular disease</measure>
    <time_frame>2007-2013</time_frame>
    <description>Ischemic heart disese Cerebrovascular accident with codes Arterial peripheral disease with codes Heart failure with codes Cardiovascular procedures such as coronary revascularization, revascularization and non-traumatic lower extremity amputation</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Diagnosis of Diabetic retinopathy</measure>
    <time_frame>2007-2013</time_frame>
    <description>Diabetic retinopathy on the DTALL date</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Causes of mortality in the population with type 2 diabetes during the study period</measure>
    <time_frame>2007-2013</time_frame>
    <description>Causes of mortality in the population with type 2 diabetes during the study period</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Cost analysis</measure>
    <time_frame>2007-2013</time_frame>
    <description>Pharmacological treatment, which will include pharmacological treatment of diabetes complications.&#xD;
Number of visits carried out by primary care professionals (physician, nurse and other)&#xD;
Visits carried out by specialists.&#xD;
Number of referrals.&#xD;
Medical tests.&#xD;
Sick leave days&#xD;
Hospital admissions (number of days in hospital and cost)&#xD;
Number of test strips used for self-monitoring.</description>
  </primary_outcome>
  <enrollment type="Actual">300000</enrollment>
  <condition>Diabetes Mellitus</condition>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>current clinical practice</intervention_name>
    <description>quality management (data registration, drug prescription, diagnostic and clinical tests ...), in primary care of patients with diabetes mellitus</description>
  </intervention>
  <eligibility>
    <study_pop>
      <textblock>
        Study population is selected from 5,8 million people from the 282 primary care centres of&#xD;
        the Catalan Health Service identified with an anonymized personal identifier and included&#xD;
        in a unique patient registry called &quot;SIDIAP&quot; for primary care in Catalonia (North East&#xD;
        region in Spain)&#xD;
      </textblock>
    </study_pop>
    <sampling_method>Non-Probability Sample</sampling_method>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Female and male patients &gt; 30 years of age with a clinical record in the SIDIAP&#xD;
             database.&#xD;
&#xD;
          -  Patients with a diagnosis of type 2 diabetes (codes ICD10: E11, E11.0-E11.9, E14,&#xD;
             E14.0-E14.9) on June 30 (DTALL) of each year.&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Patients with a diagnosis of type 1 diabetes (E10), gestational diabetes (O24),&#xD;
             secondary diabetes (E12) or any other type of diabetes (E13)&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>31 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Josep Franch</last_name>
    <role>Principal Investigator</role>
    <affiliation>IDIAP JORDI GOL</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>IDIAP Jordi Gol</name>
      <address>
        <city>Barcelona</city>
        <country>Spain</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>Spain</country>
  </location_countries>
  <verification_date>September 2017</verification_date>
  <study_first_submitted>May 5, 2015</study_first_submitted>
  <study_first_submitted_qc>September 12, 2017</study_first_submitted_qc>
  <study_first_posted type="Actual">September 14, 2017</study_first_posted>
  <last_update_submitted>September 14, 2017</last_update_submitted>
  <last_update_submitted_qc>September 14, 2017</last_update_submitted_qc>
  <last_update_posted type="Actual">September 15, 2017</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor</responsible_party_type>
  </responsible_party>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Diabetes Mellitus</mesh_term>
  </condition_browse>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03283774
org study id: GOL-DML-2015-01
nct id: NCT03283774
lead sponsor: 
has dmc: Yes
Main Objective: To identify changes in metabolic control of type 2 diabetes in patients of
      the Catalan national health system during 2007-2013.

      Study design: Follow-up of a population with type 2 diabetes during 7 years (2007-2013).

      Study participants: Approximately 300,000 people with a clinical record in the SIDIAP
      database.

      Source: SIDIAP database. Variables and measurements: Age, gender, time since diagnosis of
      type 2 diabetes, associated cardiovascular risk factors, micro- and macrovascular
      complications of diabetes, causes of mortality, treatment for hyperglycaemia and for
      modifiable risk factors, other conditions related to diabetes and its management. The
      economic costs of diabetes during the study period will also be analyzed.

      Analysis: The clinical variables will be described and 95% confidence intervals will be
      calculated for the main variables associated with the study outcomes. Missing values will
      count as non-existing data and missing value imputation will not be used in the analysis. If
      a subgroup of patients is considered of particular interest, sub analyses will be carried
      out. Predictive variables of good metabolic control and of complications and mortality of
      diabetes will be analyzed with the hazard ratios for each factor.

      Results:

      Applicability: The results related to control of diabetes will serve as a basis for improving
      metabolic control and decreasing chronic complications and to optimize cost-effectiveness of
      treatments.

      Significance: A long-term study of a population receiving usual treatment is required to
      understand the changes in indicators of metabolic control, morbidity and mortality and in the
      management of the disease.

      Limitations: Those associated with the use of large population databases.
Main Objective

      • To determine the changes in metabolic control of type 2 diabetes during 2007-2013 in
      patients of the main Catalan public health provider (Catalan Health Service-CHS).

      Secondary Objectives

        -  To describe changes in HbA1c values in the Catalan population with type 2 diabetes
           during 2007-2013.

        -  To describe changes and control of modifiable cardiovascular risk factors (blood
           pressure, lipid profile, smoking and obesity) in the Catalan population with type 2
           diabetes during 2007-2013.

        -  To identify factors associated with changes in HbA1c and in the variables of metabolic
           control during the study period.

        -  To describe changes in the prevalence of macrovascular (ischemic heart disease,
           cerebrovascular accident, peripheral arterial disease) and microvascular complications
           (kidney disease, retinopathy) in the Catalan population with type 2 diabetes during
           2007-2013.

        -  To describe changes in mortality in the Catalan population with type 2 diabetes during
           2007-2013.

        -  To analyse the main costs of diabetes in Catalonia during 2007-2013.

        -  To describe changes in the use of hypoglycaemic agents in the Catalan population with
           type 2 diabetes during 2007-2013.

        -  To describe changes in the use of medicines to control cardiovascular risk factors
           (antihypertensive, hypolipidemic and antiplatelet agents) during 2007-2013.

      Hypothesis During 2007-2013 the metabolic control of type 2 diabetes patients in the public
      health system of Catalonia (CHS) improves. The management of type 2 diabetes incorporates new
      pharmacological treatments.

      Methods

      Study Design Longitudinal study with cross-sectional, yearly analysis for each year of the
      study period (2007-2013).

      Reference Population and Study Population A longitudinal study with a cross-sectional yearly
      analysis on June 30 of each year (DTALL) in those patients with a verified type 2 diabetes
      diagnosis will be carried out with SIDIAP data.

      The observation period will be the calendar years 2007 (baseline), 2008, 2009, 2010, 2011,
      2012 and 2013 (final).

      The SIDIAP database includes the following information of the 5.8 million people from the 282
      primary care centres of the Catalan Health Service linked with a unique, anonymized personal
      identifier:

        1. Information from the electronic clinical records (eCAP): demographic data, visits to the
           primary care centre, health conditions (codes ICD-10), clinical variables,
           prescriptions, immunizations and referrals.

        2. Blood tests results: will be directly retrieved from the laboratories databases.

        3. Information on the medication dispensed in pharmacies: obtained from the pharmacy
           billing database of the Catalan Health Institute (CatSalut).

      Data Collection and Information Sources The data sources are constituted by the electronic
      clinical records, blood tests results, the pharmacy register of the SIDIAP database and
      mortality data from AQuAS (Health Quality and Evaluation Agency of Catalonia)

      Since the study does not target any specific treatment and no specific medication is
      considered an exposure therapy under investigation, no definition of exposure to any
      medication is included.

      Data Analysis

      Data analysis will be performed on study patients meeting inclusion criteria. The clinical
      variables will be described in terms of absolute and relative frequency for qualitative
      variables. Central tendency and dispersion measures will be used to describe quantitative
      variables as appropriate and 95% confidence intervals will be calculated for the main
      variables associated with the study outcomes.

      Statistical tests will be used to compare the distribution of risk factors over time (DTALL):
      ANOVA will be used for normally distributed quantitative variables, the non-parametric
      equivalent (Kruskal-Wallis) will be used for non-normally distributed variables, and
      chi-square test will be used for categorical variables. The P value of the linear trend over
      the different time periods will be calculated for each variable. The cost associated with
      diabetes will be calculated for each time cohort.

      The likelihood-ratio test will be used to test for interaction between the study variables
      (eg, HbA1c or cardiovascular events) in nested models with the terms of interaction included
      or removed. To analyse changes over time of variables to control diabetes in the study
      cohorts from 2007 to 2013, repeated measures ANCOVA and multinomial logistic regression
      analysis will be used for quantitative and categorical variables, respectively. These models
      will be then be adjusted for potential confounders.

      The incidence rate per year will used to analyse the frequency of events during the follow-up
      period (eg. ischaemic heart disease, stroke). The Cox proportional hazard model will be
      adjusted for potential confounders. Linearity and risk proportionality will be graphically
      verified in every model using mean weighted residuals.

      Missing values will count as non-existing data and missing value imputation will not be used
      in the analysis.

      Statistical comparisons will be performed using two-tail hypothesis testing with level of
      significance of 0.05. Data management will be conducted by IDIAP Jordi Gol personnel using
      the SIDIAP database and data analysis will be conducted by epidemiologists and statisticians.

      Study Limitations The main limitations of the study derive from the quality of the register
      of big databases. Previous studies with the SIDIAP showed the validity of most of the
      variables used in the current protocol.

      Ethics

      Confidentiality The study will follow the International Guidelines for Ethical Review of
      Epidemiological Studies (Council for the International Organizations of Medical Sciences
      -CIOMS-, Geneva, 1991), and the Declaration of Helsinki (revision 64th WMA General Assembly,
      Fortaleza, Brazil, October 2013).

      The management, communication and transfer of data of the participants will comply with the
      Protection of Personal Data Organic Law of December 13, 15/1999.

      Amendments in the study protocol will be communicated in writing to all investigators and to
      the appointed Clinical Research Ethics Committee (CREC) and to the competent authorities
      according to the order sas / 3470/2009.

      Risk-benefit assessment The current study involves solely access to a database where the data
      are anonymized and unlinked. It does not carry therefore any risk for the patients.

      Data Confidentiality All information in the SIDIAP database is anonymized and unlinked.

      Use of electronic data Data extraction will be carried out from the SIDIAP electronic
      database.

      Follow-up and final reports A final report with the results obtained will be reviewed and
      approved by the IDIAP Jordi Gol researchers. No interim reports are anticipated.

      The report should be written following dates in the workplan; a copy of the report will be
      sent to the Clinical Research Ethics Committee that has authorised the study.

      Conditions of Publication The results of this retrospective, observational study will be
      published in international journals with mention of the Clinical Research Ethics Committee
      and the sources of funding. None of the investigators will communicate to any third party the
      results of the study before final results and interpretation have been agreed.

      Clinical Research Ethics Committee (CREC) The IDIAP Jordi Gol CREC will evaluate this study.

      Conflict of Interests AstraZENECA will provide funding through a contract with the IDIAP
      Jordi Gol Foundation.

      AstraZENECA will not interfere in data extraction, analysis and presentation of reports. The
      funding is unlinked to the results of the study.
observational model: Ecologic or Community
time perspective: Prospective
measure: Diagnosis of the most common cardiovascular risk factors
time frame: 2007-2013
description: High Blood Pressure (more then >140/90mm Hg), Dyslipidaemia, Smoking and Obesity
measure: Level of of glycated haemoglobin (HbA1c)
time frame: 2007-2013
description: The value closer and prior to the DTALL date will be considered. A window of up to a year before the DTALL date will be accepted (i.e., from July 1 of the previous year up to DTALL)
measure: Average of the three last measurements of systolic and diastolic blood pressure
time frame: 2007-2013
description: A window of up to a year before the DTALL date will be accepted (i.e., from July 1 of the previous year up to DTALL). If there are no 3 BP measurements, the average of 2 measurements or the value closer and prior to DTALL will be accepted
measure: Levels of Total Cholesterol (TC), LDL Cholesterol (LDL-C), HDL Cholesterol (HDL-C), triglycerides (TGC) and non-HDL Cholesterol.
time frame: 2007-2013
description: A window of up to a year before the DTALL date will be accepted (i.e., from July 1 of the previous year up to DTALL)
measure: Body Mass Index (BMI)
time frame: 2007-2013
description: A window of up to a year before the DTALL date will be accepted (i.e., from July 1 of the previous year up to DTALL). BMI values and calculation of BMI with weight in kg and height in m will be accepted. The height value accepted will be that closer to DTALL measured after 18 years of age. Priority will be given to the calculation with weight in kg and height in m over a BMI value. The date of the calculation of the BMI with the weight and height will determine the weight value
measure: Kidney function: glomerular filtration estimated by MDRD
time frame: 2007-2013
description: The value closer and prior to the DTALL date will be considered. A window of up to a year before the DTALL date will be accepted (i.e., from July 1 of the previous year up to DTALL)
measure: Kidney function: urinary albumin excretion (albumin/creatinine ratio).
time frame: 2007-2013
description: The value closer and prior to the DTALL date will be considered. A window of up to a year before the DTALL date will be accepted (i.e., from July 1 of the previous year up to DTALL)
measure: Use of hypoglycaemic agents (oral and/or GLP1) and insulin on the DTALL date
time frame: 2007-2013
description: Monotherapy and combined therapy with other hypoglycaemic agents will be analysed. Dosage will not be specified. Data of use will be obtained from the pharmacy billing of the Catalan Health Service (CatSalut).
measure: Use of antihypertensive, hypolipidemic, antiplatelet and anticoagulant agents on the DTALL date
time frame: 2007-2013
description: Monotherapy and therapy combined with hypoglycaemic agents will be analysed. Dosage will not be specified.
Data of use will be obtained from the pharmacy billing of the Catalan Health Service (CatSalut)
measure: Cardiovascular disease
time frame: 2007-2013
description: Ischemic heart disese Cerebrovascular accident with codes Arterial peripheral disease with codes Heart failure with codes Cardiovascular procedures such as coronary revascularization, revascularization and non-traumatic lower extremity amputation
measure: Diagnosis of Diabetic retinopathy
time frame: 2007-2013
description: Diabetic retinopathy on the DTALL date
measure: Causes of mortality in the population with type 2 diabetes during the study period
time frame: 2007-2013
description: Causes of mortality in the population with type 2 diabetes during the study period
measure: Cost analysis
time frame: 2007-2013
description: Pharmacological treatment, which will include pharmacological treatment of diabetes complications.
Number of visits carried out by primary care professionals (physician, nurse and other)
Visits carried out by specialists.
Number of referrals.
Medical tests.
Sick leave days
Hospital admissions (number of days in hospital and cost)
Number of test strips used for self-monitoring.
intervention type: Other
intervention name: current clinical practice
description: quality management (data registration, drug prescription, diagnostic and clinical tests ...), in primary care of patients with diabetes mellitus
study pop: 
sampling method: Non-Probability Sample
criteria: 
gender: All
minimum age: 31 Years
maximum age: N/A
healthy volunteers: No
last name: Josep Franch
role: Principal Investigator
affiliation: IDIAP JORDI GOL
facility: 
country: Spain
responsible party type: Sponsor
mesh term: Diabetes Mellitus