The extended cascade of type 2 diabetes care in Belgium: a population-based study

Abstract Background Type 2 diabetes (T2D) is a major public health challenge, yet a comprehensive assessment of the quality of T2D care in Belgium is lacking. We therefore developed an extended cascade of T2D care that integrates the traditional care continuum stages with a broad range of guideline-recommended follow-up process indicators, and identified individual- and practice-level determinants of follow-up care. Methods We used cross-sectional Belgian health insurance and Belgian Health Examination Survey data among adults aged ≥ 40 years to estimate the cascade of T2D care. Furthermore, using longitudinal health insurance data on a cohort of T2D patients, we estimated within-between random effects logistic regression models to assess individual- and practice-level determinants of follow-up care. Results The diabetes prevalence among adults aged ≥ 40 years was 11.9%, of whom 93.7% had been tested, 77.9% were diagnosed, and 75.9% were linked to care. Follow-up performance varied substantially across indicators: 69.8% of those with T2D received annual serum creatinine testing, 47.1% received statins, 46.0% received at least two HbA1c measurements, and 24.1% had an eye examination. Overall, 45.4% achieved glycaemic control. Better T2D follow-up care was generally associated with older age, gaining entitlement to increased reimbursement for healthcare expenditure, developing additional comorbidities, an increase in the number of distinct primary care practices contacted, and moving from single-handed fee-for-service to group or capitation-based primary care practices. Conclusions The timely and accurate detection of T2D and the delivery of appropriate follow-up care represent key bottlenecks along the Belgian T2D care continuum. The findings also highlight important inequalities in follow-up care across patient and practice characteristics, underscoring the need for targeted strategies to improve T2D follow-up care.