Examples from EUCID data: blood pressure, overweight and smoking in diabetics

This section focuses on data collected on physical and behavioural risk factors in diabetics. In total, six indicators are included in this EUCID category:

• Blood pressure tested
• Blood pressure >140/90
• BMI in diabetes population tested
• BMI in diabetes population => 25
• BMI in diabetes population => 30
• Smoking in diabetes population

All of these factors have a well defined normal value and a cut off point where intervention is agreed upon. The consensus is that all of these risk factors should be measured at least annually. Most of the data originate from clinical databases, as national or regional samples that were more or less representative for the national population. The complete set of indicators can be found in the final report of the EUCID project.

As examples for EUPHIX, data are reproduced on the proportion of the diabetics tested that have a high blood pressure, are overweight, and smoke.

Hypertension prevalence in diabetics ranges from 17% to 46%

The upper limit of an acceptable blood pressure is different in different guidelines. The value has decreased over the years. The acceptable limit of 140/90 mm Hg is the highest in use at the moment. This threshold was selected to avoid discussion between the supporters of the different guidelines.

12 Countries were able to provide data for this indicator in the EUCID project, as shown by the Crude percentages of the diabetic population with blood pressure measured in the last 12 months and above 140/90 mm Hg. The percentage of the diabetic population with a blood pressure above the selected threshold varies from 17% in France to 46% in Sweden. In all countries, there is a clear age effect, with the percentages varying from 10-20% around age 30, to 30-80% at age 85.

For more information on the occurrence, prevention, treatment and consequences of hypertension see the EUphact Blood Pressure.

A related set of data from EUCID shows that between 45% (Ireland) and 99% (the Netherlands) of diabetics are regularly tested for their total cholesterol levels.

In diabetics, the prevalence of overweight, including obesity, ranges from 60 to 82%

Overweight and especially obesity are risk factors for macrovascular disease as well as modifiers for the effectiveness of blood glucose treatment. All the guidelines have included BMI (Body Mass Index) as a measurement that should be performed at least once a year. BMI is defined as body weight divided by the square of body length (kg/m2). Normally, 4 categories are used for BMI values:

• below 20.0: underweight
• 20.0 to 24.9: optimal weight
• 25.0 to 29.9: overweight
• 30.0 and above: obesity

The ideal BMI, also for the diabetes population, is between 20 and 25.

12 Countries were able to provide this indicator in the EUCID project. As can be seen in the Crude percentages of overweight and obesity in the diabetic population > 25 years, the majority of the diabetic population has a BMI above 25. The percentages of the diabetic population with a BMI above 25 vary from 59% to 83%. In most countries the percentage of the diabetic population with a BMI above 30 is a little higher than the percentage with a BMI between 25 and 30. These values found for the diabetic population are substantially higher than in the general population, in almost all the countries.

For more information on the occurrence, prevention, treatment and consequences of overweight see the EUphact Overweight.

Smoking in diabetics ranges from 10-37%

Smoking is a risk factor for macrovascular disease. All guidelines advise people with diabetes to stop smoking.

11 Countries were able to provide this indicator in the EUCID project. As shown in the Crude percentages of current smokers in the diabetic population > 25 years, the percentage of diabetics who smoke varies from 10% (Ireland) to 37% (Denmark). Important variations between countries are observed which may reflect the impact of various public health policies. On average, there are no striking differences when compared to the general population. However, it is important to note that the EUCID project and the EUphact Smoking rely on different definitions for smoking and on different data sources. Data gathering has been difficult for this indicator, which might influence the reliability of the data since the data relied upon self-reporting of the people with diabetes and clinical databases are not always well updated on this item.