Concurrent control of blood glucose, pressure, lipids, and body mass in patients with type 2 diabetes and comparison with the 2013 Chinese guidelines: a cross-sectional study

Abstract

BackgroundDiabetes has rapidly become an epidemic in recent decades, and in 2008, the prevalence of type 2 diabetes was reported to be 9·7% in China. According to the China National Basic Public Health Services implemented in 2009, local public health services should take charge of management of patients with chronic diseases, including diabetes. The 2013 Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes has set comprehensive goals for control of the disease. The aim of this study was to assess concurrent control of blood glucose, pressure, lipid, and body mass in patients with diabetes in comparison with the 2013 Chinese Guidelines. MethodsA cross-sectional study with stratified cluster sampling was conducted in Changshu county and Huai'an City of Jiangsu Province. According to criteria by America Diabetes Association, 39 564 patients diagnosed with type 2 diabetes have registered and received management of the National Basic Public Health Services in 2012. 23 240 patients with type 2 diabetes in 44 public health service centers within 65 townships were sampled, and 20 340 individuals agreed to participant in the survey, which consisted of a structured epidemiological questionnaire and physical examination between December, 2013, and January, 2014. Fasting blood samples were collected to measure glycated haemoglobin A1c (HbA1c), fasting blood glucose, and lipid profiles. Blood pressure, weight, height, and body-mass index (BMI) were also measured and calculated. This study was approved by the ethic committe of Jiangsu Provincial Center for Disease Control and Prevention (2013026), and informed consent was obtained from each participant. Findings20 053 patients with type 2 diabetes were included in the study. The mean age of the participants was 62·8 years (SD 9·9), and 12190 (60·8%) patients were female. 8370 (42%) patients had controlled HbA1c concentration below 7·0%, and 6291 (31%) patients had fasting blood glucose concentration below 7·0 mmol/L. 15 406 (77%) patients had hypertension, and 4876 (24%) patients had controlled blood pressure (systolic blood pressure <140 mm Hg and diastolic blood pressure <80 mm Hg). The prevalence of dyslipidemia was 48% (9715 of 20 053 patients); 11 119 (55%) patients had controlled triglyceride concentrations (<1·7 mmol/L), 4774 (24%) patients had controlled total cholesterol (<4·5 mmol/L), 4439 (22%) patients had controlled LDL-cholesterol concentration (<1·8 mmol/L with cornary heart disease and <2·6 mmol/L without the disease), and 15 115 (75%) patients had controlled HDL-cholesterol concentration (>1·0 mmol/L in men and >1·3 mmol/L in women). 7186 (36%) participants had BMI less than 24·0 kg/m2. InterpretationThe glycaemic control is quite low in the present study, and even fewer patients had gained control of blood pressure and body mass. Nearly half of the participants had dyslipidemia. More intensive management of diabetes and comorbidities is warranted in the Chinese population. FundingJiangsu Provincial Health Department (K201105).