Acta Diabetologica

, Volume 55, Issue 11, pp 1171–1179 | Cite as

Type 2 diabetes and treatment intensification in primary care in Finland

  • Leo NiskanenEmail author
  • Jarmo Hahl
  • Jari Haukka
  • Elli Leppä
  • Tatu Miettinen
  • Vasili Mushnikov
  • Raija Sipilä
  • Nadia Tamminen
  • Pia Vattulainen
  • Pasi Korhonen
Original Article



To identify how the electronic health record (EHR) systems and national registers can be used for research purposes. We focused on how the primary care physicians adhere to clinical guidelines.


Study population included incident type 2 diabetes patients from four selected regions. Data were collected in two phases. At the first phase study cohort was identified using the prescription registers of the Social Insurance Institution (SII) and EHR systems used within the study regions. At second phase, data were collected from SII’s registers, local EHR systems, the hospital discharge and the primary care registers of National Institute for Health and Welfare.


Metformin was the most common choice as first drug. Among all study patients, 8375 (76.0%) started metformin monotherapy or combinations. The treatment was intensified at variable levels of HbA1c depending on the area. DPP4-inhibitors were by far the most common agent for treatment intensification. Sulphonylureas were used less often than basal insulin as the second-line agent. The use of DPP4-inhibitors increased between years 2009–2010, when first DPP4-inhibitor received reimbursement and this class became dominant drug for treatment intensification increasingly thereafter.


The EHR systems and national registers can be used for research purposes in Finland. The realization of diabetes treatment national guidelines are followed in primary care to a large extent. However, the subsequent intensification of therapy was delayed and occurred at elevated Hba1c levels.


Diabetes Electronic health records Drug treatment Current care guidelines Type 2 diabetes 


Compliance with ethical standards

Conflict of interest

The authors declare conflicts of interest regarding this manuscript as follows: Leo Niskanen—no conflicts of interest regarding this manuscript. Hahl, Jarmo -Epid Research Ltd, Payment for contributing. Leppä, Elli—No conflict of interest. Miettinen, Tatu—Epid Research Ltd, Payment for contributing. Mushnikov, Vasili—Pharma Industry Finland, Payment to Epid Research Ltd. Jari Haukka, Vasili Mushnikov, Pia Vattulainen and Pasi Korhonen work for EPID Research. EPID Research is a contract research organization and thus its employees have been and currently are working in collaboration with several pharmaceutical companies.

Human and Animal Rights

The whole study plan was approved by the Ethical Review Board of Helsinki University Hospital (HUS May 2013).

Informed consent

This is a register-based study with anonymous data and no patient contacts. Thus no consents from anonymized patients were required according to Finnish law.

Supplementary material

592_2018_1199_MOESM1_ESM.docx (33 kb)
Supplementary material 1 (DOCX 32 KB)


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Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  • Leo Niskanen
    • 1
    • 2
    Email author
  • Jarmo Hahl
    • 3
  • Jari Haukka
    • 4
  • Elli Leppä
    • 5
  • Tatu Miettinen
    • 3
  • Vasili Mushnikov
    • 6
  • Raija Sipilä
    • 7
  • Nadia Tamminen
    • 8
  • Pia Vattulainen
    • 6
  • Pasi Korhonen
    • 6
  1. 1.Endocrinology and DiabetologyHelsinki University HospitalHelsinkiFinland
  2. 2.University of Eastern FinlandKuopioFinland
  3. 3.Medaffcon LtdEspooFinland
  4. 4.Department of Public HealthUniversity of HelsinkiHelsinkiFinland
  5. 5.Pharmaceutical Information Centre LtdOuluFinland
  6. 6.EPID Research LtdEspooFinland
  7. 7.Current Care GuidelinesThe Finnish Medical Society DuodecimHelsinkiFinland
  8. 8.Pharma Industry FinlandHelsinkiFinland

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