The doctoral dissertation in the field of Epidemiology will be examined at the Faculty of Health Sciences at Kuopio Campus.
What is the topic of your doctoral research? Why is it important to study the topic?
Type 2 diabetes (T2D) is a common chronic disease worldwide and an increasing concern in Finland. It raises the risk of serious complications such as cardiovascular disease, kidney failure, and premature death. High-quality care can prevent or delay many of these outcomes; however, it was found that care quality varies across and within countries.
This dissertation examined the quality of routine care for people with T2D, with a particular focus on two central treatment indicators: glycated haemoglobin (HbA1c), which reflects long-term blood glucose levels, and low-density lipoprotein cholesterol (LDL), a primary risk factor for cardiovascular disease. It explored how these markers were monitored and managed in real-world clinical settings over time and how care patterns varied across different patient groups. In addition, it investigated the effects of the COVID-19 pandemic on the use of routine services, including remote consultations, in-person appointments, and laboratory testing.
What are the key findings or observations of your doctoral research?
One key finding is the substantial heterogeneity in patients’ care processes and outcomes. Some patients showed persistently poor or worsening patterns, and these groups had significantly higher risks of mortality and vascular complications such as stroke, heart failure, and amputation. Patients with both poor HbA1c and LDL levels over time had the highest risk of adverse outcomes. Statin use and LDL monitoring were frequently suboptimal, especially in women and in patients with high-stable LDL levels. Another key finding is importance of a longitudinal perspective: similar values at a single time point can mask very different risk trajectories over time.
The COVID-19 pandemic caused a temporary decline in in-person visits, especially among older and high-need patients. Remote consultations helped to maintain some continuity, but they rarely occurred without at least some in-person care. Despite reduced service use, no short-term deterioration in HbA1c or LDL levels was observed during the early pandemic period.
In addition, the study highlights the value of routinely collected electronic health record data for identifying gaps in care and monitoring population-level trends in treatment and outcomes, demonstrating its potential to support continuous learning in health systems.
Taken together, this research offers a comprehensive, real-world view of T2D care in one Finnish region over a decade, providing insights on key patterns in treatment outcomes, health service use and the associated outcomes under both routine conditions and during care disruptions.
How can the results of your doctoral research be utilised in practice?
The findings of this study have several practical implications. First, they suggest that clinicians and health systems may benefit from using trajectory-based monitoring of key risk factors to identify high-risk patients and enable earlier interventions, especially for those with worsening trends.
Second, this research highlights the importance of timely and appropriate intensification of statin therapy, especially for patients who continue to have high LDL levels. Clinical inertia, or failure to adjust treatment in response to poor control, remains a challenge.
Third, the study underscores the need to maintain both remote and in-person care. While virtual consultations can support continuity in times of disruption, access to laboratory testing and physical assessments remains essential.
What are the key research methods and materials used in your doctoral research?
This dissertation is based on four studies, all of which used EHR data from the public healthcare system in North Karelia, including laboratory measurements, diagnoses, prescriptions, and service contacts for all people with T2D in the region.
Growth Mixture Models were used to analyse HbA1c and LDL trajectories over five years, grouping patients by similar trends. The associations between these trajectory groups and adverse outcomes were assessed using Cox proportional hazards models adjusted for age, sex, disease duration, and comorbidities. Outcomes included all-cause mortality and complications such as stroke, kidney disease, and acute coronary events.
In addition, the effect of the COVID-19 pandemic on diabetes care was analysed using a before-and-after design, comparing service use and treatment outcomes in 2019 and 2020. Patients were also grouped by their pre-pandemic healthcare use to assess heterogeneity in the impact of the lockdown on care.
The doctoral dissertation of Laura Inglin, MSc, entitled Health service use and treatment outcomes in type 2 diabetes before and during the COVID-19 pandemic: A register-based study from North Karelia, Finland will be examined at the Faculty of Health Sciences. The Opponent in the public examination will be Associate Professor Merja Laine of the University of Helsinki and the Custos will be Professor, Tiina Laatikainen of the University of Eastern Finland. The public examination will be held in English.
For further information, please contact:
Laura Inglin, MSc, [email protected]
