Quality of Diabetes Care Among Obese and Overweight Patients at Nhg Polyclinics.

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The study aimed to examine the disparity of risk factor screening and clinical outcomes depending on bodyweight of patients with diabetes mellitus at 9 National Healthcare Group (NHG) Polyclinics in Singapore. Data were extracted from NHG Diabetes Registry. Diabetes care bundle measures of 8 process indicators (biannual blood pressure (BP), bodyweight and HbA1c test measurement, annual serum cholesterol level, smoking, eye, foot and nephropathy assessment) and 3 intermediate outcome indicators (HbA1c ≤ 7%, BP < 130/80 mmHg and LDL-C < 2.6mmol/L) were measured. Rates of these indicators were compared by BMI according to WHO classification. Multivariate logistic regression for achieving the individual indicators was referenced to the normal BMI group. In 2012,87,552 patients were enrolled for diabetes care at 9 NHG Polyclinics. Mean age was 64.1± 11.6. 51.8% were female. 70.6% were Chinese. 40.4% were overweight and 20.8% were obese. After adjusting for age, gender and ethnicity, overweight and obese patients were more likely to have annual cholesterol test, smoking status assessed, eye and renal function screening than normal weight patients. However, the overweight and obese class I/II patients were less likely to achieve optimal HbA1c (7% or less) and BP (< 130/80 mmHg) than normal BMI patients. The AdjOR for achieving optimal HbA1c decreased from 0.88 (95%CI 0.86-0.91) for overweight to 0.77 (0.72-0.83) for obese class II; and BP decreased from 0.74 (0.99-1.05) for overweight to 0.48 (0.45-0.52) for obesity class II. More obese class II and III patients had optimal LDL-cholesterol control compared to normal BMI patients, AdjOR 1.11 (1.03-1.19) and 1.16 (1.04-1.29) respectively. Overweight and obese patients with diabetes were less likely to achieve the optimal HbA1c and BP control than normal BMI patients. Clinicians can identify the patients with higher BMI and poor risk factor control for more intense intervention to improve diabetes care and outcomes.