University of Twente Student Theses


Preliminary phases of DMT2 early diagnosis within MST a secondary healthcare system

Slaghuis, S. (2023) Preliminary phases of DMT2 early diagnosis within MST a secondary healthcare system.

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Abstract:In 2019 there were up to 1,2 million people with the diagnosis of diabetes mellitus (DM) within the Netherlands. DMT2 is a disease that requires complex and frequent healthcare and therefore has a significant impact on the Dutch healthcare system. As these patients are a part of Dutch society and many are part of the Dutch working population, they also impact the Dutch economy directly and indirectly through significant healthcare consumption, both in primary and secondary healthcare. DMT2 cannot yet be cured, making early diagnosis and prevention essential. In comparison to DMT2, its preliminary phases, hyperinsulinemia, and prediabetes can be reversed. As these phases are present years to decades before the onset of DMT2 early diagnosis and treatment of these preliminary phases of DMT2 could prevent the development of DMT2. This would increase the QALYs of the individual, relieve the Dutch healthcare system of the DMT2 burden, and minimize its impact on the Dutch economy. Therefore, this Master Thesis research will map to which extent this early diagnosis initiative is applied within MST, a secondary healthcare system. The research question is as follows: To what degree do medical doctors of MST perform early diagnosis for preliminary phases of diabetes mellitus type 2 within their patient population and which factors influence this implementation process? The Master Thesis does consist of literature research and an empirical study. Literature was used to build early diagnoses intervention criteria, and to indicate and understand the essential building blocks for a preliminary phases of DMT2 early diagnoses intervention. By comparing DMT2 and the Dutch secondary healthcare system to these criteria, their fit for early diagnoses was analyzed and current implementation limitations and impediments were identified. These findings did portray the current early diagnoses implementation in Dutch secondary healthcare to be in the first stage of implementation according to Wensing and Grol: Orientation. The recommended pathophysiology to test for is insulin resistance, but more medical trials are required to indicate the most valid testing method. Most importantly, more research has to be conducted to provide the required insights into the preliminary phases of DMT2 early diagnoses its cost-effectiveness, its eligible patient population, and prediabetes treatment cost-effectiveness. The empirical study does answer questions aiming at exploring the early implementation stage within MST a secondary healthcare system, by the usage of a survey and interview with internist Mattijs Out. An online survey conducted in Qualtrics explored the knowledge of, basal support for and experienced impediments to prediabetes early diagnosis by internists in MST. Eleven internists responded in total. Four internists(users) stated to test for insulin resistance within their patient population and seven(non-users) stated not to test for insulin resistance. Among all users, the knowledge was declared to be moderate to excellent. For the non-users this reached from limited to excellent, with the majority stating mediocre or sufficient, and more education on this matter was requested. The basal support is present. All internists test for glucose regulation and all internists, but one, who are not yet testing for insulin resistance are willing to test for insulin resistance. Who should be responsible for prediabetes early diagnosis is debated upon. Their opinions are distributed between primary and secondary care. There is however consensus on prediabetes early diagnosis within secondary healthcare being a task for internal medicine and optionally for interfering medical specializations. Important impediments to early diagnosis implementation stated by internists are lack of evidence of its cost-effectiveness, lack of time, lack of healthcare budget, lack of education, and lack of protocols. These impediments seem to be a nationwide problem within secondary healthcare. Other impediments stated by the literature are a lack of evidence on testing method accuracy, on the effectiveness of prediabetes early diagnosis and prediabetes treatments, and on indications for prediabetes risk patient populations. Many impediments, such as lack of time, budget, and protocols are a result of the lack of cost-effectiveness evidence. These stagnations can be explained by the need for evidence, before the providence of budgets and time by health insurance. Therefore, health insurance support and intervention implementations are often years behind scientific findings. This implies more research must be conducted on the cost-effectiveness of testing methods, prediabetes early diagnosis, prediabetes treatments, and eligible risk patient population selection, before hospitals and health insurance will provide the required budgets enabling prediabetes early diagnosis to become implemented within the Dutch secondary healthcare system
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Programme:Health Sciences MSc (66851)
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