Type 2 diabetes and treatment intensification in primary care in Finland

Acta Diabetol. 2018 Nov;55(11):1171-1179. doi: 10.1007/s00592-018-1199-7. Epub 2018 Aug 6.


Aim: To identify how the electronic health record (EHR) systems and national registers can be used for research purposes. We focused on how the primary care physicians adhere to clinical guidelines.

Methods: Study population included incident type 2 diabetes patients from four selected regions. Data were collected in two phases. At the first phase study cohort was identified using the prescription registers of the Social Insurance Institution (SII) and EHR systems used within the study regions. At second phase, data were collected from SII's registers, local EHR systems, the hospital discharge and the primary care registers of National Institute for Health and Welfare.

Results: Metformin was the most common choice as first drug. Among all study patients, 8375 (76.0%) started metformin monotherapy or combinations. The treatment was intensified at variable levels of HbA1c depending on the area. DPP4-inhibitors were by far the most common agent for treatment intensification. Sulphonylureas were used less often than basal insulin as the second-line agent. The use of DPP4-inhibitors increased between years 2009-2010, when first DPP4-inhibitor received reimbursement and this class became dominant drug for treatment intensification increasingly thereafter.

Conclusions: The EHR systems and national registers can be used for research purposes in Finland. The realization of diabetes treatment national guidelines are followed in primary care to a large extent. However, the subsequent intensification of therapy was delayed and occurred at elevated Hba1c levels.

Keywords: Current care guidelines; Diabetes; Drug treatment; Electronic health records; Type 2 diabetes.

MeSH terms

  • Aged
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Drug Utilization*
  • Female
  • Finland
  • Humans
  • Hypoglycemic Agents / therapeutic use*
  • Male
  • Middle Aged
  • Practice Guidelines as Topic
  • Primary Health Care / standards*
  • Primary Health Care / statistics & numerical data


  • Hypoglycemic Agents