Micro- and macrovascular complications among Greenlanders and Danes with type 2 diabetes mellitus in Nuuk, Greenland.

OBJECTIVES: To estimate the prevalence of micro- and macrovascular complications and risk factors among Greenlanders and Danes with type 2 diabetes mellitus (T2DM) in Nuuk, Greenland. STUDY DESIGN: Observational and cross-sectional study, based on a review of medical records and patient interviews. METHODS: Review of the electronic medical records and interviews obtained from T2DM patients connected to the Center of Primary Health Care in Nuuk. RESULTS: A total of 123 patients (81 Greenlanders and 42 Danes) with T2DM for a mean of 6 years were included. Fifty-seven percent of the Greenlanders were diagnosed within the last 3 years. Ninety-one percent of the patients had BMI>or=25 kg/m(2), 42% had 1 or more first-degree relatives with diabetes, 43% were current smokers, 69% were categorized as leading a very physically active lifestyle and 60% described a healthy diet pattern. Sixty-eight percent of all the patients suffered from at least 1 complication - 51% neuropathy, 14% retinopathy, 10% macrovascular complication and 43% microalbuminuria. The number of complications was significantly correlated to the duration of diabetes (p=0.008) and low physical activity (p=0.037). Retinopathy was correlated to Danish ethnicity (p=0.020). CONCLUSION: The majority of the Greenlandic patients (57%) were diagnosed within the last 3 years, which may indicate either the beginning of an epidemic or an increased awareness of T2DM, or both. The high prevalence of microvascular complications and risk factors such as smoking and microalbuminuria are a matter of concern. Efforts to reduce smoking and increase physical activity could be considered as prime targets for initiatives.

Prevalence of the use of antihypertensive medications in Greenland: a study of quality of care amongst patients treated with antihypertensive drugs.

OBJECTIVES: The primary objective was to estimate the prevalence of patients diagnosed with hypertension using the proxy marker of antihypertensive drug therapy in Greenland and to compare the prevalences within the 5 health regions in Greenland. The second objective was to review 2 quality indicators in antihypertensive care. STUDY DESIGN: Observational and cross-sectional study reviewing electronic medical records. METHODS: Information about age and gender was collected from all patients receiving antihypertensive drug prescriptions within a 2-year period prior to the data extraction in January 2011. Only patients aged 20 or above were included. The age- and gender-specific prevalence of patients in antihypertensive treatment was calculated using the population as it was 1 January 2010 in Greenland as background population. A subsample consisting of patients in antihypertensive treatment aged 20 or above born within the first 5 days of each month was identified. Review of electronic medical records 1 year back in time (1 January 2010 onwards) was carried out and information on blood pressure obtained. The quality of care was evaluated with respect to 2 indicators: follow-up management and blood pressure level, respectively. RESULTS: The total number of patients in treatment with antihypertensive drugs was 4,462 (1,998 males and 2,464 females) corresponding to a prevalence of 11.4% (4,462/39,231). The prevalence was higher among females than among males. The prevalence increased with age and differed among the 5 health regions. The percentage of patients in antihypertensive treatment with minimum 1 follow-up visit within 1 year (blood pressure measured and registered in a health clinic) was only 77.7%. Some 45% of patients in antihypertensive treatment achieved blood pressure below 140/90 mmHg. CONCLUSION: Hypertension is a common disorder in Greenland. The quality of antihypertensive care is suboptimal and leaves room for improvement. A national strategy based on guidelines, use of electronic drug prescriptions and recording of blood pressures combined with continuous monitoring the quality is recommended in order to prevent complications of untreated hypertension.

Frequent use of primary health care service in Greenland: an opportunity for undiagnosed disease case-finding.

OBJECTIVES: To estimate the age- and gender-specific consultation rates of patients who availed primary health care service in Greenland and to analyse contact patterns among patients in Nuuk. DESIGN: Observational and cross-sectional register study using data captured from the medical records. MATERIALS AND METHODS: The number of patients specified by age and gender who had contacted the primary health care centres within the last year was identified using a statistic module applied to the electronic medical records system. The population as it was on the 1st of January 2011 was used as the background population. The age- and gender-specific consultation rates were calculated. Review of most recent contact was performed in a subsample of patients from Nuuk, and information of the type of contact and diagnoses was obtained. RESULTS: Eighty-three percent of the population in Greenland had been in contact with the primary health care centre within the last year. Females were more frequent users than males. A subsample of 400 patients in Nuuk was identified. Personal contact was the most frequent type of consultation (75.8%), followed by telephone (14.8%) and e-mail (9.8%) consultations. Musculoskeletal symptoms accounted for the most frequent bases for diagnoses. CONCLUSION: More than 80% of the whole population has been in contact with the primary health care system within the last year. This indicates that opportunistic case-finding of chronic diseases such as diabetes, hypertension, etc. providing a possible strategy for decreasing the number of undiagnosed cases.

Prevalence of gestational diabetes mellitus among women born in Greenland: measuring the effectiveness of the current screening procedure.

OBJECTIVES: To estimate the prevalence of gestational diabetes mellitus (GDM) among Greenlanders and to evaluate the quality of the current screening procedure for gestational diabetes. STUDY DESIGN: Observational retrospective study of consecutive birth-log data and medical records on pregnant women who had given birth in Nuuk during 2008. METHODS: Information about maternal weight, weight gain in pregnancy, height, blood pressure, result of oral glucose tolerance test, family history of diabetes, smoking and alcohol habits, ethnicity, delivery and birth weight and length was collected for women who had given birth in Nuuk, Greenland, during 2008. RESULTS: A total of 233 women born in Greenland who had given birth to a singleton in Nuuk 2008 were included in the study. Of those, 37% were defined as having a high risk for GDM and thus met the screening criteria for GDM used in Greenland. However, only 54% of those women were screened. The prevalence of gestational diabetes was calculated to be 4.3% among high-risk Greenlandic pregnant women (2/46) (95% CI 0-10.0%). CONCLUSIONS: Despite a suboptimal screening rate, the prevalence of GDM among Greenlanders seems to be relatively low and Greenlanders may thus be less prone to develop GDM. However, diabetes mellitus is a relatively new disease in Greenland, and glucose intolerance in pregnancy is more likely to affect the next generation. The screening rate is suboptimal, and it is recommended that the screening procedure be optimized in order to find and treat all women with GDM. The number of screened women compared to the number of births occurring annually could be used as an indicator of screening efficacy. Diabetes prevention initiatives should be given high priority to avoid high rates of GDM in the future, as increasing prevalence of the disease is now seen worldwide, regardless of race.