Diabetic Control at a Family Medicine Clinic in Taiwan

Abstract

The aim of this study was to provide an overview of diabetic care status by non-endocrinologists in Taiwan. A retrospective study was carried out in Taiwan, involving randomly selected patients diagnosed with non-insulin dependent diabetes mellitus who attended outpatient clinic of the Department of Family Medicine at National Taiwan University Hospital over a 3-month period between January 2003 and March 2003. A total of 2,042 patients diagnosed as diabetes mellitus were collected via ICD code number, of which 508 were selected via systematic sampling, and 385 patients were finally recruited into this study by interview and medical records review. The overall mean age of the 385 patients was 63 years old and the percentage of male to female ratio was about equal. The average duration of disease was 8 years and their average BMI was 26 kg/m^2, 40.9% of patients had BMI ＜25 kg/m^2, their mean HbA1c of 7.6±1.6%, mean FBG level 163.9±58.9 mg/dL with majority (62.7%) FBG ＞140 mg/dL, mean blood pressure of 133/78 mmHg, triglyceride level of 185 mg/dL and cholesterol level of 203 mg/dL. The majority of the patients (92.2%) were treated with oral hypoglycemic agents (OHAs) alone or in combination with insulin (1.8%). Among the remaining 6%, 4.4% of patients were treated solely with insulin therapy; and 1.5% used dietary control exclusively. 75.5% was given sulphonylurea, 68% used biguanide, 21.9% was treated with insulin sensitizer (excluding biguanide). 63.7% of patients were using 2 or more kinds of OHAs concurrently. 23.1% of patients self-monitored their sugar level. Of which, one patient did urine glucose monitoring only. The frequency of self-monitoring was 8.2 times per month. 26.3% had records pertaining to neuropathy, 55.8% checked for proteinuria, 36.1% of patients had eyeground data. According to the patient chart records, 70.9% of patients had history of hypertension, 66% had hyperlipidemia, 21.6% had coronary artery disease, and 11.2% had history of stroke. Our study concluded that by measuring HbA1c, the glycemic control in diabetic patients cared by family physicians at medical center is tantamount to those cared by the endocrine specialists, though some room still exists to perfection. However, the rate of screening for diabetic complications is low, thus more education and better awareness of the potential to delay diabetic complications must be emphasized.