Control and complications of diabetes in urban primary care units in Thailand: a cross-sectional study.

BACKGROUND: Primary health care system plays a central role in caring for persons with diabetes. Thai National Health Examination Survey (NHES) reports that only 40% of patients with type 2 diabetes mellitus (T2DM) achieve optimal glycemic control. We sought to evaluate the quality of diabetic care (QOC), prevalence of microvascular complications, and associated risk factors among T2DM patients treated at primary care units in urban areas in Thailand. METHODS: A population-based, cross-sectional study of 488 T2DM patients aged over 35 years from 25 primary care units in Samutsakhon, Thailand was conducted during February 2018 to March 2019. Clinical targets of care (TOC) and processes of care (POC) were measured to evaluate QOC. Multivariate logistic regression models were applied to explore the association between risk factors and glycemic control. RESULTS: 41.2% of women and 44.4% of men achieved hemoglobin A1C (A1C) < 53 mmol/mol, while 31.3% of women and 29.7% of men had poor glycemic control (A1C > 63 mmol/mol). 39 participants (8%) achieved all TOC and 318 participants (65.2%) achieved all POC. Significant risk factors for poor glycemic control included diabetes duration > 6 years (AOR = 1.83, 95% CI = 1.20-2.79), being overweight (AOR = 2.54, 95% CI = 1.58-4.08), obesity (AOR = 1.71, 95% CI = 1.05-2.89), triglycerides > 1.7 mmol/l (AOR = 1.81, 95% CI = 1.25-2.78), low density lipoprotein-cholesterol (LDL-C) ≥ 2.6 mmol/l (AOR = 1.55, 95% CI = 1.04-2.28). On the other hand, participants aged > 65 years (AOR = 0.25, 95% CI = 0.14-0.55) or achieved TOC indicators (AOR = 0.69, 95% CI = 0.43-0.89) were significantly associated with glycemic control. Diabetic retinopathy was significantly related to obesity (AOR = 2.21, 95% CI = 1.00-4.86), over waist circumference (AOR = 2.23, 95% CI = 0.77-2.31), and diastolic blood pressure > 90 mmHg (AOR = 1.81, 95% CI = 1.48-1.96). CONCLUSION: Access to essential diabetic screening in primary care units is crucial to determine status of disease control and guide disease management. Duration of T2DM, high body mass index, triglyceride and LDL-C were independently associated with poor glycemic control. Obesity was highly associated with diabetes retinopathy. Effort should be taken seriously toward monitoring these factors and providing effective care.

Glycemic control and microvascular complications among type 2 diabetes at primary care units.

OBJECTIVE: To determine the status of disease control and to compare the prevalence of microvascular complications among type-2 diabetes in a primary care setting. MATERIAL AND METHOD: The authors performed a cross-sectional study of 287 diabetic patients from 13 primary care units in urban areas of Thailand The status of diabetic control was dominantly defined by HbA(1C) (A1C), blood pressure (BP). Screening programs for microvascular complications included retinopathy and nephropathy. Retinopathy used a seven-field stereoscopic retinal photography while nephropathy was defined by a random urine albumin-to-creatinine ratio. RESULTS: The AIC of 41.3% of the patients was lower than 7% however 80% of them used only low doses of anti-diabetic drugs. The prevalence of microalbuminuria was 28.7% and macroalbuminuria was 5.7%, whereas diabetic retinopathy was 15.1%. In multivariate analyses, nephropathy was significantly related to duration of diabetes > or =4 years (odds ratio 1.5, 95% CI 1.2-1.8, p < 0.001) and A1C > or =8% (odds ratio 2.2, 95% CI 1.3-3.8, p < 0.05), while retinopathy was related to duration of diabetes > or =4 years (odds ratio 9.5, 95% CI 1.17-77.8, p < 0.05). CONCLUSION: The present study shows that primary care units provides patients with well-controlled diabetes. Nonetheless, those type 2 diabetes patients have significantly higher rates of microvascular complications, despite shorter diabetes duration and lower A1C. Type 2 diabetic patients in primary care unit should be screened for complications and efforts should be done to reach optimal glycemic level, especially for individuals with diabetes > or =4 years.