The status of glycemic control: A cross-sectional study of outpatients with type 2 diabetes mellitus across primary, secondary, and tertiary hospitals in the jiangsu province of China

Abstract

Objectives: The aims of the study were to determine the following: the status of glycemic control in patients with type 2 diabetes mellitus (DM) at primary, secondary, and tertiary hospitals in the Jiangsu province of China; and the factors associated with achieving glyce-mic targets. Methods: This study, in which patients were enrolled from July 20 to 31, 2009, at 56 diabetes centers, used a multiple-stage, stratified sampling method to select a representative sample of the population with DM in Jiangsu. The sampling process was stratified by geographic and demographic regions, and by the outpatient numbers in the hospitals. A primary hospital was defined as a community medical institution that provided primary health services; a secondary hospital was a local medical institution that provided comprehensive health services; and a tertiary hospital was a regional medical institution that provided comprehensive and specialist health services. In primary hospitals, patients with DM were treated by general physicians; at secondary and tertiary hospitals, they were seen by specialists. Also, primary and tertiary hospitals treated patients in cities, whereas secondary hospitals treated patients from towns or rural areas. Patients with a medical history of type 2 DM for >6 months and registration at each diabetes center for ≥6 months, and who were residents of Jiangsu province, were recruited. During the patient enrollment visit, information about DM complications and comor-bidities, as well as DM management, was obtained by retrospectively reviewing medical records; basic patient data (eg, date of birth, sex, weight, height) were obtained by patient interview. Blood samples were collected for assessment of glycosylated hemoglobin (HbA 1c) at a central laboratory. Results: Of 3046 sampled subjects, the analysis was performed in 2966 subjects with complete data. The mean (SD) HbA 1c value for analyzed patients was 7.2% (1.6%). The proportion of patients with tight glycemic control was 40.2% (1193/2966) when a threshold of HbA 1c <6.5% was used, and 56.1% (1665/2966) when a threshold of HbA 1c <7.0% was used. Compared with patients who had inadequate glycemic control, those with tight control were younger ( P < 0.001), had shorter duration of DM ( P < 0.001), had lower body mass index (BMI) ( P = 0.005 for HbA 1c <6.5% and P = 0.01 for HbA 1c <7.0%), had more education ( P < 0.001) and income ( P = 0.003 for HbA 1c <6.5% and P = 0.008 for HbA 1c <7.0%), were more likely to monitor their glucose ( P = NS for HbA 1c <6.5% and P = 0.043 for HbA 1c <7.0%) and attend DM education ( P = 0.027 for HbA 1c <6.5% and P = 0.002 for HbA 1c <7.0%) at least once a month, and were more likely to receive oral antidiabetic drugs (OADs) ( P < 0.001). Age, BMI, and DM duration did not differ significantly between hospital types. Compared with primary (36.2%) and secondary hospitals (36.5%), tertiary hospitals (42.2%) had more patients with HbA 1c <6.5% ( P = 0.043); tertiary hospitals also had more patients with once-monthly glucose self-monitoring ( P = 0.001), patients with higher income ( P < 0.001) and education ( P < 0.001), and those who were more likely to use ≥2 OADs or insulin with OADs ( P < 0.001). Conclusion: The overall status of glycemic control was unsatisfactory during the study period, although patients at tertiary hospitals appeared to have better control than those at primary or secondary hospitals.