Hypoglycemic drug adjustment and other factors related to reaching target glucose in type 2 diabetic patients under community management: Beijing Community Diabetes Study 9

Abstract

Objective To analyze the impact of antidiabetic drugs adjustment and other related factors on reaching target glucose in type 2 diabetic patients under community management. Methods Total 3201 patients with type 2 diabetes from 15 community health service centers in Beijing were enrolled in the study, who entered the community diabeta management program from August 2008 to July 2011. According to the glucose-lowering drugs adjustment during 3 years intervention period, patients were divided into 4 groups: 255 patients (8.0%) in insulin-added group, 641 (20.0%) in oral hypoglycemic drugs-added(OHA)group, 1621 (50.6%) in hypoglycemic drug-constant group and 684 (21.4%) in drug-reduced group. Results The hemoglobin A1c(HbA1c) levels were reduced from(8.3±1.9)%, (7.4±1.7)%, (6.8±1.3)% and(7.2±1.5)% to (7.5±1.5)% (t=5.38, P 0.05), respectively in above 4 groups after 3 years management; the rates of HbA1c-reduction>0.5% unit were 52.2%(133/255), 34.3%(220/641), 24.6%(399/1621) and 31.9%(218/684), respectively. In 562(43.9%)out of 1280 cases whose HbA1c≥7% before entering the management program, the HbA1c levels reached to <7.0%(P<0.01); the rate of reaching recommended target of HbA1c(48.4%) was significantly higher in OHA group than that of other 3 groups. After 3 years management the blood glucose control rates in patients with low, middle and high educational backgrounds were 61.5%(342/556), 64.7% (1174/1814)and 74.5%(619/813); those in patients with low, middle and high economic levels were 58.1%(971/1670), 77.3%(828/1071) and 66.8%(137/205), respectively(P<0.01). Multivariant logistic regression analysis showed that adding insulin, adding OHA, per capita income ￥2000-4000/M, BMI reduction during management period and age of patients were independent related factors for decrease in HbA1c, with odds ratio (OR) of 0.45, 0.80, 0.72, 0.96 and 1.08(P<0.05). Conclusion By management of hypoglycemic drugs actively, patients with type 2 diabetes in Beijing communities show significant improvement in HbA1c levels from 2008 to 2011, but the low educational back ground and low-income groups still should be the primary focus. Key words: Community health services; Diabetes mellitus, type 2; Glycosylated hemoglobin; Antidiabetic agents