Quality and Efficiency of Diabetes Care in Sweden – National Performance Assessment 2011

During 2011, the National Board of Health and Welfare undertook a national assessment of the quality and efficiency of Swedish diabetes care. This report comprises conclusions and recommendations, as well as open indicator-based comparisons of some particularly important areas for improvement.


The National Board of Health and Welfare's performance assessment of Swedish diabetes care shows that health care providers comply well with the National Guidelines for Diabetes Care 2010. In many areas, diabetes care show positive results and trend data indicate steady improvements. For instance usage of diabetes drugs as well as usage of test strips to measure blood sugar levels, generally speaking, follows the recommendations in the Guidelines. More persons with diabetes also reach the target level for LDL-cholesterol and blood pressure, and more patients undergo regular foot examinations and retinopathy screening. However there are a few areas where county councils and municipalities can improve their diabetes care. These are mainly areas of care where there are significant differences between county councils and municipalities.

Health care providers, both hospital-based diabetes clinics and primary health care units, can improve diabetes care by:

  • Intensifying the care for persons with diabetes with a HbA1c level of more than 73 mmol/mol for instance by more frequent visits to diabetes nurses and physicians in order to reduce the proportion of persons with HbA1c level above 73 mmol/mol (Indicator B2).
  • Reviewing their procedures and making more use of multidisciplinary foot teams if they belong to those with the highest amputation rates (Indicator A2).
  • Screening more persons with diabetes for urinary albumin excretion (Indicator C3) in order to earlier detect and prevent kidney damage.
  • Providing advice and support, as well as prescribing exercise as treatment to help increase the proportion of people with diabetes who regularly undertake physical activity (Indicator D1).
  • Offering effective smoking-cessation methods to reduce the proportion of smokers among persons with diabetes (Indicator D2), especially among younger persons with Type 2 diabetes.
  • Offering group-based patient education by staff trained in adult learning approaches in order to improve patients’ self-care (Indicator F1, Indicator F2a).
  • Offering culturally-adapted patient education to persons with different cultural backgrounds with the aim to improve patients’ self-care (Indicator F2b).
  • Using established classifications and coding systems for registration of diagnosis and interventions in order to improve monitoring and evaluation of diabetes care.

Diabetes care is also provided by the municipalities as they are responsible for short-term and long-term special housing, domestic assistance for persons living in their own housing and home-based curative health care provided by nurses and auxiliary staff employed by the municipality. Municipalities can improve diabetes care by:

  • Providing specific diabetes care training and further education for their staff as to enhance their knowledge.
  • Improving their written routines concerning delegation as to prevent mistakes related to drugs and insulin dosages.
  • Testing knowledge before delegation as to prevent mistakes.
  • Introducing updated diabetes care programmes based on current, evidence-based recommendations for diabetes care as to ensure that care is provided on equal terms for all patients.

The above recommendations are intended to facilitate the county councils’, hospitals/health units’ and municipalities’ regular work aimed at improving diabetes care. Our purpose is to highlight areas where the quality did not reach a desired level in the country as a whole. However, individual municipalities, county councils and hospitals/health units may already have reached a sufficiently high level in one or more of the indicators.

The National Board of Health and Welfare will in particular monitor performance of the indicators on which their recommendations are made, as well as monitoring other indicators. This will be done in connection with the next assessment of diabetes care, which will be initiated in a few years’ time. Future performance assessment will also include analysis of socio-economic aspects. By then the municipalities, county councils and hospitals with weaker results will have been able to improve their results.

Read the full Summary

Year: 2014
Article number: 2014-3-18
Format: POD
Pages: 64
Language: Engelska
Price (VAT included): 90 kr