Hemoglobin Alc achievement rate and self-management ability in patients of different clinical stages receiving Diabetes Shared Care

Abstract

Objective To investigate the hemoglobin Alc (HbA1c) achievement rate and self-management ability of type 2 diabetes patients of different clinical stages receiving Diabetes Shared Care at Peking University First Hospital. Methods This study summarized the data of type 2 diabetes patients who were under regular follow-ups for Diabetes Shared Care at Peking University First Hospital from October 2016 to June 2018. HbA1c levels and the expenditure of anti-diabetic drugs were collected at the first visit (V1), second visit (V2, 3 months after V1), third visit (V3, 6 months after V1), fourth visit (V4, 9 months after V1), and fifth visit (V5, 12 months after V1). The summary of diabetes self-care activities-6 (SDSCA-60) for the evaluation of self-management ability was collected at V1 and V5. Also, the patients were divided into five groups in accordance with the duration of diabetes: group A, 0-2.5 years; group B, >2.5-5 years; group C, >5-10 years; group D, >10-15 years; group E, >15 years. Chi-square test was performed to evaluate the HbA1c achievement rate in each group. Results A total of 232 patients who were under regular follow-ups and completed data collection were enrolled in the study, including 63 patients in group A, 14 in group B, 48 in group C, 51 in group D, and 56 in group E. HbA1c achievement rate gradually decreased along with the increase in diabetic duration (83.3% in group A to 32.0% in group E at V5). Medical expenditure in groups D [15.2 (8.2, 28.0) yuan vs 14.8 (9.8, 24.1) yuan, Z=-2.253, P=0.024] and E [22.1 (14.5, 32.5) yuan vs 18.5 (10.8, 27.8) yuan, Z=-3.036, P=0.002] was higher at V5 compared to V1. Self-management ability in group A decreased with regard to exercise [4 (2, 7) vs 6 (3, 7), P=0.004] and glucose monitoring according to prescription [2 (0.75, 3) vs 3(0, 7), P=0.028]. Self-management ability increased in group C in exercise [6 (2.25, 7) vs 3 (1, 7), P=0.007], glucose monitoring [3 (1, 6.75) vs 2 (0, 4), P=0.016], and foot examination [6 (1.25, 7) vs 0 (0, 7), P<0.001], in group D in glucose monitoring [3 (1, 5.75) vs 1 (0, 5), P=0.010] and foot examination [5 (0, 7) vs 1 (0, 7), P=0.009], and in group E in glucose monitoring [4 (1, 7) vs 1 (0, 5), P=0.009]. Conclusions HbA1c achievement rate decreases along with the duration of diabetes. During the maintenance of glucose control among patients with different disease durations, the changes of self-management ability and drug expenditure are quite different. It is critical to pay more attention to self-management ability in the early stage of diabetes to overcome the difficulty along with longer diabetes duration. Key words: Disease management; Diabetes meuitus, type 2; Diabetes shared care; Self-care ability; Hemoglobin A1c