ArticleBMC public health2026
Diabetes care performance across Europe: a cascade of care approach accounting for population diversity in 10 countries.
Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDiabetes mellitus is a growing public health concern across Europe, with substantial gaps in diagnosis, treatment, and glycemic control. Despite clinical guidelines, care performance varies widely, even between high-resource countries. This study aims to assess diabetes care performance across ten European countries using a cascade of care framework and to examine whether population characteristics explain cross-country differences.
methodsWe analyzed data from 18,499 individuals aged 50 and older from wave 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE), including self-reported diabetes status, medication use, and HbA1c biomarkers. Diabetes was defined as either self-reported diagnosis, medication use, or HbA1c ≥ 6.5%. The cascade of care framework assessed three stages: diagnosis, treatment, and glycemic control. Multivariate logistic regression models adjusted for sociodemographic, socioeconomic, and health-related covariates.
resultsDiabetes prevalence ranged from 13% in Denmark to 37% in Spain and Greece, with up to 40% of cases undiagnosed. The share of individuals living with diabetes being diagnosed, in treatment and achieving glycemic control ranges between 35% and 50% depending on the country. Belgium consistently performed well across all stages, while Greece showed strong treatment and control outcomes despite low diagnostic rates. Population health profiles significantly influenced diagnostic effectiveness, with healthier individuals more likely to remain undiagnosed. Limitations include the cross-sectional design, limited indicators of the diabetes care process, and inability to distinguish diabetes types.
conclusionsDiabetes care performance varies markedly across Europe, with diagnosis representing the greatest point of attrition. Population characteristics influence care outcomes, especially at the diagnostic stage. Strengthening early detection and tailoring interventions to country-specific care gaps and population profiles are essential for improving diabetes outcomes and reducing health inequalities. Future research should explore longitudinal care trajectories and system-level determinants of care performance.
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