A cross-regional initiative for improving type 2 diabetes mellitus care quality measurement in Spain - The Diabetes Lighthouse project.

Abstract

To evaluate the quality of type 2 diabetes mellitus (T2DM) care and variability across three Spanish healthcare areas using a standardized set of quality indicators (QIs) applied to routine clinical data. This retrospective cohort study included 30,111 adults with T2DM drawn from electronic health records across three areas. Fifteen QIs, including nine process and six outcome indicators, were used to evaluate adherence to guideline-recommended monitoring and treatment. For most QIs, adherence to process indicators was below 70%. Only 20.4% of patients had timely 6-month glycosylated hemoglobin (HbA1c) follow-up, and just 3.9% of those out-of-target received quarterly checks. Sixty percent of patients with cardiovascular or chronic kidney disease received sodium-glucose cotransporter type 2 inhibitors (SGLT2i) or glucagon-like peptide type 1 receptor agonists (GLP1ras) treatment, yet only 15% received combination therapy. GLP1ras were used by 1.5% of patients with obesity. Among out-of-target patients, 41% achieved a ≥ 1% HbA1c reduction. Insulin initiation was delayed a median of 7.7 years. In summary, applying a common set of indicators across three healthcare areas proved feasible and helped identify relevant gaps in T2DM care. The Diabetes Lighthouse initiative may support quality monitoring and benchmarking, and help guide targeted improvement strategies.