1st Annual EUBIROD meeting Dasman Center for Research and Treatment of Diabetes, Kuwait City Kuwait City, Kuwait, 2nd-4th May 2009

Discussion on Theme 1: Background, Objectives and Data

First BIRO Academy Residential Course, Kuwait City, Kuwait, 2nd May 2009

The discussion has been opened by Prof.Massi Benedetti, addressing the issue of the continues evolution of the clinical review and list of parameters, thresholds and indicators, which in turn may pose the question on how to compare results obtained using different classification systems. Also, there is a need for the coexistence of different indicators, as in the case of BMI, which must be differently applied to different populations. The case applies not only to international comparisons, but also within EU countries, as these are becoming increasingly multi-ethnic. According to Fred Storms, in the BIRO classification there should be more attention on risk categories than “normal”, which usually involves 95% of the population. Furthermore, ethnicity must be measured more routinely and be included in the common dataset. That is increasingly acknowledged by healthcare organizations, since it is understood that the characteristic is important to treat subjects properly. Another example is Hba1c, whose optimal level is still under debate, but must be indeed discussed because studies show that attention to lower it actually improves outcomes.

According to Prof.Zeliko Metelko, Professor of Internal Medicine at the School of Medicine, University of Zagreb, and Director of the Vuk Vrhovac University Clinic for Diabetes, one should look at actual data definitions and choose best indicators from different angles. One example is the index albumin/creatinine, which can be a better descriptor than microalbuminuria per se. The same applies to Hba1c, for which a lower level of 6.5 can be acceptable as a cut off considering the evidence from the UKPDS. According to Prof.Matelko, the combined BIRO report should be definitely flexible and perhaps allocate more levels. However, we need also to take into account indicators for primary care prevention, e.g. education or weight gain as a percentage deviation from an optimal level. In response to Zeliko, Scott Cunningham remarks that the dataset can be revised and more items can be added at any time with the evolution of the BIRO system and the registers. Fred Storms states that the BIRO Consortium has taken into account that some of the parameters are not standardized, including the ration of albumin to creatinine.

In response to a question from the audience, Scott Cunningham reports that in Scotland the entire diabetic population is covered by the electronic register.

According to Fabrizio Carinci, the scope of registers, and then that of BIRO, is to use information in real practice conditions to improve patients' outcomes. The whole registry is for quality, thus the same applies to the choice of levels, which should be given the highest priority in consideration of the direct interest of patients. In this regards, the case of Cyprus in BIRO represents a real success story since local managers used definitions to actually start a new registry.