The Swedish National Diabetes Register

The Swedish National Diabetes Register, NDR, was launched in 1996 for the purpose of promoting evidence-based development of diabetes care by offering up-to-date information about changes in the treatment of glycaemia and other risk factors, as well as diabetic complications. Another aim is to support improvement in the quality of care provided by participating units at hospitals and primary care clinics. The overall objective is to reduce morbidity and mortality, as well as to maximise the cost-effectiveness of diabetes care.

The NDR is maintained by the Swedish Society for Diabetology on behalf, and with the financial support from the Swedish Association of Local Authorities and Regions. The Swedish Diabetes Association, a patient advocacy group, actively uses the NDR as well. The NDR has been online since April 2002 (www.ndr.nu), allowing individual clinics to quickly monitor their activities on a regular basis by virtue of immediate access to their own results, as well as national statistics for purposes of comparison.

An integral part of Swedish diabetes care

The NDR, which has been an integral part of Swedish diabetes care for the past 18 years, has engaged the participation of both hospitals and primary care clinics. The register offers a unique opportunity to monitor the quality of care in terms of risk factors and the potential complications of diabetes, as well as the evolution of treatment methods. The results generated by the register have been presented at many international meetings and conferences. To our knowledge, the NDR is the largest diabetes register in the world.

Because the course of diabetes is complex and lifelong, both clinical practice and quality control of treatment measures must reflect systematic adherence to various guidelines. The NDR is an instrument to facilitate such monitoring and to disseminate findings in an accessible, transparent, comparable and timely manner. The register is both a repository of results and an educational tool for improving local quality assessment efforts. The register enables a focus on national quality indicators while following various process measures that are important at the local level.

Promoting improvement efforts

Diabetes care is largely self-managed. The NDR also promotes and facilitates the influence and participation of patients in their care and treatment. For example, patients can actively monitor data about their interactions with healthcare providers. Improved diabetes care minimises risk factors and the incidence of complications. The result is less human suffering and greater social cost benefits.

The NDR has established itself as a well-functioning tool to promote improvement efforts in the field of diabetes care. Documented evidence suggests that use of the register leads to better long-term outcomes. The critical factors for success are the emergence of healthcare systems in which measuring results is integral to the overall process, as well as training the entire team to participate in the improvement effort. Another factor that is crucial is the commitment of providers to measuring results, collecting data and discussing what they have learned. The NDR is used extensively throughout the country.