Diabetic Patients In Primary Care Research Articles

IDF2022-0937 Cohort Profile of Algerian Type 2 diabetes patients in primary care. Metabolic control and morbidity profile

IDF2022-0937 Cohort Profile of Algerian Type 2 diabetes patients in primary care. Metabolic control and morbidity profile

Monitoring of the Renal Function in the Nursing Practice

Objective: Verify the effects of intensified and usual clinical nursing monitoring on the quality of life and sedentary lifestyle of hypertensive and diabetic patients in primary care. Method: A quantitative and quasi-experimental study of time series. The sample this study consisted in 85 users allocated in control (n=45) and experimental (n=40) groups. The intervention was a nursing consultation with biochemical monitoring program. Results: With the monitoring, laboratory variables in experimental group were controlled, such as serum creatinine (0.82 – 0.79 mg/dL). The control group included 6 (26.09%) patients with renal dysfunction (p=0.001). Sedentary lifestyle was reduced in the experimental group (15.00% to 0.00%). The psychological domain of quality of life presented a better perception in the group without renal dysfunction, when compared to the users with renal dysfunction (80.8 ± 0.19 vs 51.8 ± 0.21, p=0.013). Conclusion: Results proved to be relevant for the Nursing assistance practice with reduction of sedentary lifestyle and an improvement in quality of life, the modifiable risk factors for kidney diseases.

Knowledge and Practice of Foot Self-Care Among Diabetic Patients in National Guard Primary Care in Riyadh

Objective: This study aimed to evaluate the level of knowledge and practice of foot self-care in diabetic patients in Primary care at National Guard hospital, Riyadh, Saudi Arabia. Methods: This cross-sectional study was conducted among diabetic patients attending the three biggest primary healthcare centers of the National Guard Health Affairs in Riyadh, Saudi Arabia (ISKAN clinic, HCSC, and NGCSC). The patients were asked to fill a self-administrated questionnaire that investigated demographics, knowledge, inspection, and practice. Results: Among 390 diabetic patients, 74.1% had type 2 diabetes, 6.4% had foot ulcers, and 23.1% received training on diabetic care. The knowledge score was 10.86 ± 1.66, whereas practice score was 20.2 ± 3.5. The mean score of knowledge was significantly affected by education level (p < 0.001), whereas the mean score of practice was significantly varied regarding gender (p < 0.001), education level (p-value = 0.001), occupation (p < 0.001), duration of diabetes (p-value = 0.001), and treatment (p-value = 0.001). Conclusion: Diabetic patients in this study had a good level of knowledge regarding foot self-care, whereas the practice was acceptable but not optimum.

Development and Implementation of Diabetes Care by a Community Network Based on a Chronic Care Model.

This participatory action research was conducted by the collaborative health-related team in a district, in Thailand. The community network jointly developed a care model for diabetic patients in primary care using the Chronic Care Model (CCM) and evaluated the effectiveness of implemented model. Data was collected between October 2021 and March 2022 and involved 2 groups: 1) a community network of 25 people including representatives of the community hospital, primary care hospital, Sub-district administrative organization, community leaders, community representatives, representatives of diabetic patients, and representatives of caregivers of diabetic patients, and 2) 41 people with type 2 diabetes and 41 of their family caregivers. The research was conducted in 4 stages: planning, action, observation, and reflection. Both quantitative and qualitative data were collected, and the overall average knowledge scores of diabetic patients, family caregivers, and community representatives significantly increased from before (6.07 ± 2.11, 7.07 ± 1.98, P = .024, 5.74 ± 1.88, 7.37 ± 2.25, P < .001, 7.47 ± 2.44, 8.99 ± 1.72, P = .010) respectively. For satisfaction, diabetic patients were most satisfied with family caregiver support, while the community network representatives were most satisfied with their participation in planning a model for diabetic patients in primary care. After model implementation, the blood sugar-controlled patients (HbA1c < 7 mg%) significantly increased (0 and 9.76%, P = .045), although the fasting blood sugar (FBS) of diabetic patients did not improve. The development and implementation of diabetes care based on CCM, promoted community participation and involvement in diabetes care. This model mainly affected diabetic patients who could control their HbA1c level and the satisfaction of the community network.

Underuse of cardiorenal protective agents in high-risk diabetes patients in primary care: a cross-sectional study

BackgroundSodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) have shown benefits in patients with diabetes and cardiovascular disease (CVD), heart failure (HF), and chronic kidney disease (CKD).ObjectiveWe assessed benchmark outcomes (Hemoglobin A1c, LDL-C, and blood pressure), identified the prevalence of cardiorenal indications for SGLT2i and GLP-1RA, and compared prescribing rates of GLP1-RA and SGLT2i in those with and without cardiorenal indications.MethodsWe analyzed data from January 2018–June 2019 for 7168 patients with diabetes using electronic medical records from the Northern Alberta Primary Care Research Network, a regional network of the Canadian Primary Sentinel Surveillance Network (CPCSSN). Patients with and without cardiorenal comorbidities were compared using descriptive statistics and two proportion Z tests.ResultsHemoglobin A1c ≤ 7.0% was met by 56.8%, blood pressure < 130/80 mmHg by 62.1%, LDL-C ≤ 2.0 mmol/L by 45.3% of patients. There were 4377 patients on glucose lowering medications; metformin was most common (77.7%), followed by insulin (24.6%), insulin secretagogues (23.6%), SGLT2i (19.7%), dipeptidyl peptidase-4 inhibitor (19.3%), and GLP-1RA (9.4%). A quarter of patients had cardiorenal indications for SGLT2i or GLP-1RA. Use of SGLT2i in these patients was lower than in patients without cardiorenal comorbidities (14.9% vs 21.2%, p < 0.05). GLP-1RA use in these patients was 4.6% compared with 11% in those without cardiorenal comorbidities (p < 0.05).DiscussionContrary to current evidence and recommendations, SGLT2i and GLP1-RA were less likely to be prescribed to patients with pre-existing CVD, HF, and/or CKD, revealing opportunities to improve prescribing for patients with diabetes at high-risk for worsening cardiorenal complications.

Prevalence and association of chronic musculoskeletal pain on self-management, glycemic control and quality of life among Chinese type 2 diabetes patients in primary care

AimsTo examine the prevalence of chronic musculoskeletal (MSK) pain and its association with diabetes self-management, glycemic control and health-related quality of life (HRQoL) in patients with diabetes mellitus (DM) in primary care. Methods329 patients with type 2 DM were recruited at public primary care clinics in Hong Kong. Chronic MSK pain was defined as having MSK pain ≥ 3 months, and the pain severity was measured by Brief Pain Inventory (BPI). Diabetes Management Self-Efficacy Scale (DMSES), hemoglobin A1c (HbA1c) and EuroQuol-5D (EQ5D) were collected. Multivariable regression was used to examine the association between the presence of chronic MSK pain with DMSES, HbA1c and EQ5D, adjusted for baseline confounders such as age, sex, BMI, duration of DM and comorbid depression. ResultsApproximately 49.5% of respondents reported chronic MSK pain with a median BPI severity score of 3.5 (2.0–5.0). The presence of chronic MSK pain was associated with lower HRQoL (β = −0.053, 95% CI −0.087 to −0.018, P = 0.003), but was not associated with the diabetes self-management and glycemic control. Depression was associated with poorer diabetes self-management (β = −2.776, 95% CI −4.247 to −1.304, P < 0.001) and HRQoL.( β = −0.018,95% CI-0.025 to −0.012, P < 0.001). ConclusionsChronic MSK pain was present in nearly half of the diabetic patients in primary care; however, the degree of pain was mild and had not shown to affect diabetes self-management and glycemic control. Depression was associated with poorer diabetes self-management. Chronic MSK pain and depression were both associated with poorer HRQoL.

Patient Satisfaction with Virtual Care Compared to Clinic Visit among Diabetic Patients in Primary Care

Patient Satisfaction with Virtual Care Compared to Clinic Visit among Diabetic Patients in Primary Care

Smoking cessation and glycemic control among type 2 diabetes patients in primary care, Bangkok, Thailand

Smoking cessation and glycemic control among type 2 diabetes patients in primary care, Bangkok, Thailand

Comparative study of 1- year health outcome related smoking among diabetes patients in primary care, Bangkok, Thailand

Comparative study of 1- year health outcome related smoking among diabetes patients in primary care, Bangkok, Thailand

Metformin use and the risk of total knee replacement among diabetic patients in primary care

Purpose: Metformin, apart from its glucose lowering and weight reduction effects, has recently been shown to modulate meta-inflammation, an important pathogenesis in knee osteoarthritis (OA). We aim to study the association between regular metformin use and total knee replacement (TKR) in primary care patients with diabetes.

Effect of Professional CGM (pCGM) on Glucose Management in Type 2 Diabetes Patients in Primary Care.

Little data exists regarding the impact of continuous glucose monitoring (CGM) in the primary care management of type 2 diabetes (T2D). We initiated a quality improvement (QI) project in a large healthcare system to determine the effect of professional CGM (pCGM) on glucose management. We evaluated both an MD and RN/Certified Diabetes Care and Education Specialist (CDCES) Care Model. Participants with T2D for >1 yr., A1C ≥7.0% to <11.0%, managed with any T2D regimen and willing to use pCGM were included. Baseline A1C was collected and participants wore a pCGM (Libre Pro) for up to 2 weeks, followed by a visit with an MD or RN/CDCES to review CGM data including Ambulatory Glucose Profile (AGP) Report. Shared-decision making was used to modify lifestyle and medications. Clinic follow-up in 3 to 6 months included an A1C and, in a subset, a repeat pCGM. Sixty-eight participants average age 61.6 years, average duration of T2D 15 years, mean A1C 8.8%, were identified. Pre to post pCGM lowered A1C from 8.8% ± 1.2% to 8.2% ± 1.3% (n=68, P=0.006). The time in range (TIR) and time in hyperglycemia improved along with more hypoglycemia in the subset of 37 participants who wore a second pCGM. Glycemic improvement was due to lifestyle counseling (68% of participants) and intensification of therapy (65% of participants), rather than addition of medications. Using pCGM in primary care, with an MD or RN/CDCES Care Model, is effective at lowering A1C, increasing TIR and reducing time in hyperglycemia without necessarily requiring additional medications.

The epidemiology of diabetes in the Waikato region: an analysis of primary care data.

INTRODUCTION Diabetes mellitus is common in primary care, yet little has been reported of its primary care prevalence or the clinical characteristics of patients with Type 2 diabetes mellitus (T2DM). AIM To determine the prevalence of diabetes mellitus and clinical characteristics of diabetes patients in primary care in the Waikato region. METHODS Primary care data were extracted from the electronic records of 15 general practices for patients aged >20 years with current diabetes mellitus at 20 June 2017. Diabetes mellitus was defined as having a glycated haemoglobin (HbA1c) of ≥50mmol/mol (6.7%) or having being dispensed two or more anti-diabetic medications in the previous 12 months. Additional data collected included patients' ethnicity, age, sex and years since diagnosis. RESULTS The overall prevalence of diabetes mellitus was 5.7% and was higher for Māori (8.6%), Asian (7.0%) and Pacific peoples (9.1%) than Europeans (5.0%; all P<0.001). For patients with T2DM for whom current diabetes annual review data were available (n=2227) the mean body mass index (BMI) was 32.8±0.2kg/m2, but BMI was higher in Māori, younger patients, females and patients diagnosed <2 years previously (all P<0.001). Similarly, HbA1c levels were highest in Māori and younger patients (both P<0.001), with 40% of patients overall having a HbA1c of ≤53mmol/mol (7.0%). Approximately 70% of all patients had at least one measure of hypertension (systolic ≥130 or diastolic ≥80mmHg), or dyslipidaemia. More than 85% of patients had completed a recent retinal screen and foot check. DISCUSSION We found that management of T2DM was suboptimal, with measures for many patients not meeting clinical targets. Support should be provided to improve weight and glycaemic management, particularly for Māori, females and younger patients.

Rates and Factors Associated With Laxative Prescription Among Type 2 Diabetes Patients in Primary Care

Background: Diabetes mellitus (DM) is a common noncommunicable disease. Several gastrointestinal symptoms such as diarrhea, chronic constipation, and fecal incontinence are often observed in DM patients; among these, chronic constipation is the most commonly reported. Given the growing prevalence of diabetes-associated chronic constipation, the problem of laxative prescribed without diagnosis of constipation among type 2 diabetes patients has been found in the primary care unit. Therefore, it should attend to investigate the rate and factors associated with laxative prescription in type 2 diabetes.&#x0D; Objective: To evaluate the rate and factors associated with laxative prescription in type 2 diabetic patients at the primary care unit and general practitioner outpatient clinic at Songklanagarind Hospital.&#x0D; Results: Overall, 386 patients diagnosed with type 2 diabetes were enrolled (55.7% female; mean age, 63.3 years; median duration of type 2 diabetes, 7 years; median visit in 5 years of each patient, 44 visits). Prevalence of laxative prescriptions was 16.6%. Rate of laxative prescriptions was 1.7% within 5 years. Patients with no diagnosis constipation according to ICD-10 about 81.2%. The statistically significant factors associated with laxative prescriptions in diabetic patients were age, number of hospital visit in 5 years, duration of type 2 DM disease, height, diastolic blood pressure, hemoglobin, hematocrit, serum uric acid, and glomerular filtration rate.&#x0D; Conclusions: Most laxative prescribed diabetic patients were without written diagnosis of constipation. Factors associated with laxative prescriptions were age, number of hospital visit, duration of type 2 DM disease, height, diastolic blood pressure, hemoglobin, hematocrit, serum uric acid, and glomerular filtration rate.&#x0D;

Evaluation of knowledge and education of physicians to diabetic patients in primary care in Saudi Arabia

Background: Effective treatment of diabetes is not enough alone, there must be education and training from physicians and nurses to patients. To achieve education in correct manner there must be enough knowledge of physicians to apply care and teaching of these patients. The aim of the study was to evaluate the knowledge and education of physicians to diabetic patients in primary care in Saudi Arabia.Methods: Successive evaluation investigation through questionnaire. The work universe was made up of the 83 service areas of the 15 municipalities of Saudi Arabia, the sample of the total of the incorporated areas was initially made up of 625 health providers and 2,171 people with diabetes.Results: At the beginning of the study, the highest percentage of health providers surveyed declared that they did not know (78%) or that it was not defined (16.6) who should educate the person with diabetes, while the results at the end of the study show that 32% mentioned the doctor and the nurse and 62.7 the entire team of work (p=0.000) with a more adequate vision on the definition of responsibility for the fulfilment of this task and a generalized knowledge (97.5) of the existence of an education program in d diabetes that was useful for their compliance.Conclusions: Extension of the diabetes education program to Saudi Arabia achieved a significant change in the opinions of health providers on the health problem.

Risk factor management of type 2 diabetic patients in primary care in the Scandinavian countries between 2003 and 2015

AimsTo observe and report population demography, comorbidities, risk factor levels and risk factor treatment in a sample of individuals treated for type 2 diabetes in primary care in Norway, Sweden and Denmark. MethodsRetrospective observational cohort using extraction of data from electronic medical records linked with national health care registries. ResultsSixty primary care clinics participated with annual cross-sectional data (2003 to 2015). In 2015 the sample consisted of 31,632 individuals. Mean age (64.5–66.8 years) and proportion of women (43–45%) were similar. The prevalence of cardiovascular disease in 2015 was 40.7%, 41.6% and 38.0% for Norway, Sweden and Denmark, respectively and 84% to 89% of patients were receiving a pharmacological anti-diabetic treatment. More Danish patients reached targets for HbA1c and LDL cholesterol, while more patients in Sweden and Denmark met the blood pressure target of <130/80 mmHg as compared to Norway. ConclusionsIn three comparable public primary health care systems we found a high prevalence of cardiovascular disease and differences in risk factor treatment and attainment of risk factor goals. With recent guideline changes there is potential for further prevention of diabetes complications in primary care in the future.

1188-P: Approaches to and Inertia in Cardiovascular and Renal Risk Management of Type 2 Diabetes Patients in Primary Care: Results from a Global Quantitative Survey

Background: Despite recent recommendations for the use of glucose-lowering therapies with additional cardiovascular (CV) and renal benefits, as demonstrated through CV outcomes trials (CVOTs), many patients (pts) with type 2 diabetes mellitus (T2D) managed in primary care remain on therapeutic regimens now considered suboptimal. This global survey of primary care physicians (PCPs) investigated current approaches to early CV and renal risk management of pts with T2D. Methods: This web-based, global, quantitative panel survey of PCPs and primary care diabetes specialists (PCDSs) constituted 20 demographic, Likert scale, and multiple-choice questions covering the current management of pts with T2D, particularly the use of second/third line therapies (sodium-glucose co-transporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and dipeptidyl peptidase-4 inhibitors). Results: Globally, 1558 PCPs and 119 PCDSs from 18 countries completed the survey. Respondents saw a mean 132 pts with T2D per month and had treated pts with T2D for 17 years. Overall, 73% of PCPs and 72% of PCDSs were responsible for second/third line treatment initiation. The biggest barrier to second/third line treatment initiation identified by respondents was local healthcare systems/insurance companies restricting access to these therapies. Concerns over safety, pt disinterest, and difficulties in maintaining regular appointments were also identified as significant contributors to treatment inertia. Only 68% of PCPs and 52% of PCDSs were aware of data published from recent CVOTs, while 68% and 58%, respectively, stated they had changed their treatment decisions based on these trials. Conclusions: Significant barriers still prevent optimization of T2D pt care in the primary setting, including limited familiarity of PCPs and PCDSs with new CVOT data, treatment inertia, and access restrictions for second/third line treatments. Disclosure S. Brunton: Advisory Panel; Self; Abbott, Bayer U.S., Merck &amp; Co., Inc., Xeris Pharmaceuticals, Inc. Speaker’s Bureau; Self; Lilly Diabetes. Other Relationship; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., Novo Nordisk Inc. F. Cos: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Lilly Diabetes, Novo Nordisk A/S, Sanofi. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk A/S, Sanofi. G.F. Deed: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Lilly Diabetes. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Lilly Diabetes, Merck Sharp &amp; Dohme Corp., Novartis AG, Novo Nordisk Inc., Sanofi-Aventis. N. Kanumilli: Advisory Panel; Self; Abbott, AstraZeneca, Boehringer Ingelheim International GmbH, Janssen Pharmaceuticals, Inc., Novartis AG, Novo Nordisk A/S. Consultant; Self; Boehringer Ingelheim International GmbH, Sanofi-Aventis. Speaker’s Bureau; Self; Napp Pharmaceuticals. P.R. Kushner: Advisory Panel; Self; Abbott, AstraZeneca, Bayer U.S., Janssen Pharmaceuticals, Inc., Novo Nordisk Inc. Speaker’s Bureau; Self; AstraZeneca, Janssen Pharmaceuticals, Inc. P.J. Lin: Speaker’s Bureau; Self; Abbott, AstraZeneca, Bausch + Lomb, Bayer Inc., Boehringer Ingelheim (Canada) Ltd., Eli Lilly and Company, Mead Johnson Nutrition, Merck &amp; Co., Inc., Novo Nordisk Inc., Sun Pharmaceutical Industries Ltd. Other Relationship; Self; Elsevier. J. Nolte: Advisory Panel; Self; AstraZeneca. Funding AstraZeneca

Impact of comorbidity on health-related quality of life among type 2 diabetic patients in primary care.

Health-related quality of life (HRQL) is an important outcome for chronic diseases such as diabetes mellitus that is associated with complications, comorbidities, and lifelong care. The present study aims to explore the impact of comorbidities on the different dimensions of HRQL among type 2 diabetic patients attending primary care. A total of 912 type 2 diabetic patients attending primary care centers in India were assessed using a predesigned and pretested questionnaire - Diabetes Comorbidity Evaluation Tool in Primary Care. The HRQL was measured by physical and mental health summary scores [physical component summary (PCS) and mental component summary (MCS)] of the Short Form Health Survey 12. The associations of sociodemographic variables and clinical variables with PCS and MCS were assessed, and a minimal difference of 5 in the scores (on a scale of 0-100) was kept as clinically relevant difference for this study. Mean differences in mental (MCS) and physical (PCS) scores of quality of life by number and type of comorbid conditions in type 2 diabetic patients were calculated. The presence of comorbid conditions was associated with lower scores of PCS and MCS (P < 0.001). Significant reduction in HRQL was found with increase in number of comorbid conditions, and negative association was established between the number of comorbidities and the PCS (r = -0.25, P < 0.0001) and MCS scores (r = -0.21, P < 0.0001). Among comorbidities, acid peptic disease, chronic lung disease, visual impairment, depression, and stroke had significantly and clinically relevant reduced scores. Duration of diabetes, use of insulin, and obesity were also associated with poor HRQL. Comorbidities considerably impair the HRQL among type 2 diabetic patients. National programs designed for diabetes management should also take into account the challenges of coexisting chronic conditions and its substantial effect on HRQL.

1280-P: Effect of Professional CGM (pCGM) on Glucose Management in Type 2 Diabetes Patients in Primary Care

Background: Very little data exists regarding the impact of CGM in the primary care management of type 2 diabetes (T2D). We initiated a QI project in a large health care system to determine the effect of pCGM on glucose management. We evaluated a MD model, and an RN/Certified Diabetes Educator (CDE) model. Methods: Patients (pts) with T2D for &amp;gt;1 year, A1C ≥7.0 and &amp;lt;11.0%, managed with any T2D regimen, and willing to use pCGM were included. Baseline A1C was collected and pts wore a pCGM (Libre Pro) up to 2 weeks followed by a visit with MD or RN/CDE (MD consultation if needed) to review CGM data including Ambulatory Glucose Profile (AGP). Shared decision making was used to modify lifestyle and medication regimen. Clinic follow-up in 3-6 months included an A1C and in a subset a repeat CGM. Results: Sixty-eight pts average age 61.6 years, average duration of T2D 15 years, mean A1C 8.8%, were identified. Pre to post pCGM lowered A1C from 8.8 ± 1.2% to 8.2 ± 1.3% (n=68, p=0.006). The time in range (TIR) and time in hyperglycemia improved along with slightly more hypoglycemia in the subset of 37 pts who wore a second pCGM (Table). Glycemic improvement was largely due to lifestyle counseling (68% of pts) and intensification of current therapy (65% of pts), and not due to addition of medications. Conclusion: Using pCGM in a primary care setting, with an MD or RN/CDE model, is effective at lowering A1C, increasing TIR and reducing time in hyperglycemia. Disclosure T.W. Martens: Research Support; Self; Abbott Laboratories, Dexcom, Inc., Medtronic, Novo Nordisk Inc. R.M. Bergenstal: Research Support; Self; Abbott, Boehringer Ingelheim Pharmaceuticals, Inc., Dexcom, Inc., Glooko, Inc., Hygieia, JDRF, Johnson &amp; Johnson Medical Devices Companies, Lilly Diabetes, Medtronic MiniMed, Inc., Merck &amp; Co., Inc., National Institute of Diabetes and Digestive and Kidney Diseases, Novo Nordisk Inc., Roche Diabetes Care, Sanofi. Other Relationship; Self; Abbott, Helmsley Charitable Trust, Hygieia, Lilly Diabetes, Novo Nordisk Inc., Onduo LLC, Sanofi, UnitedHealth Group Inc. M.L. Johnson: Research Support; Self; Abbott, Calibra Medical, CeQur Corporation, Dexcom, Inc., Medtronic, National Institute of Diabetes and Digestive and Kidney Diseases, Novo Nordisk Inc., Sanofi. J.L. Davidson: None. G. Simonson: Advisory Panel; Self; Merck &amp; Co., Inc. Research Support; Self; Abbott. Funding Abbott Laboratories

967-P: Association between Visit-to-Visit Blood Pressure Variability and Blood Glucose Control, a Retrospective Analysis of Three Population-Based Cohorts of Diabetic Patients

Background: Relationship between blood pressure (BP) and blood glucose control is still unsure. This study aimed to find whether visit-to-visit variability (VVV) of BP could be an independent risk factor for blood glucose control. Methods: A retrospective analysis was conducted in 95254 Chinese primary care diabetic patients from Oct. 2014 to Nov. 2018 with repeated measurements of BP and fasting plasma glucose (FPG) every 3 months, including 3 cohorts: Putuo District diabetes cohort (PTD, N=43590), Xuhui District diabetes cohort (XHD, N=45451) and Changning District diabetes cohort (CND, N=6213). The VVV of systolic blood pressure (SBP) was evaluated by average successive difference (ASD), and glucose control was evaluated by “FPG well-controlled proportion” (FPG≤7mmol/L as “well-controlled”), over 16 follow-ups. Logistic regression was used to explore the association of SBP ASD and FPG well-controlled proportion. The full model adjusted the baseline characteristics considering age, gender, BMI, exercise, medication and diet. Model was built in PTD and validated in the other 2 cohorts. Results: Patients in PTD can be divided into 3 groups by VVV of SBP, which were “stable,” “fluctuating” and “highly fluctuating” groups. With “stable” group as reference, higher VVV of SBP was associated with lower FPG well-controlled proportion. In PTD, “fluctuating” group, OR: 1.18, 95% CI: 1.13-1.24; “highly fluctuating” group, OR: 1.42, 95% CI: 1.35-1.49. Results were consistent in the 2 validated cohorts and ORs for the “highly fluctuating” group were 2.37, 95% CI: 2.23-2.52 and 1.34, 95% CI: 1.15-1.56. In the whole population (N =95254), “highly fluctuating” group was associated with the worst blood glucose control with OR: 1.67, 95% CI: 1.62-1.73. Conclusion: High VVV of SBP could be an independent risk factor for blood glucose control, which suggests extra surveillance for those with highly fluctuating SBP. Disclosure S. Zhang: None. L. Xie: None. W. Zhang: None. B. Qian: None.

Regularity, treatment adherence and outcome among diabetic patients in primary care: an overview

Early detection and compliance to prescribed treatment is the cornerstone to avert life threatening complications among those with non-communicable diseases (NCD). Assessing regularity of visits, adherence to medication and its correlates can help in devising effective strategies to improve medication adherence. The objective of the study was to review about regularity, treatment adherence and outcome among diabetic patients in primary care. In this literature review, electronic data sources viz. Pub Med, Proquest, Google Scholar, Research gate with the use of the keywords or Mesh words like “Diabetes,” “Primary Health care” “Treatment adherence” “Regularity of treatment” “process of care indicators” and “outcome indicators” were searched. The searches were limited to studies reported in English and were available as free full text from January 2009 to June 2018. Related articles including descriptive cross-sectional, cohort, randomized controlled trials, qualitative studies and systematic reviews were also extracted and refined further. From our review it’s clearly evident that the level of Diabetic care in terms of regularity and follow-up is suboptimal compared to standards established in developed nations. There is a wide scope for improvement in diabetic care as demonstrated successfully in many nations using regular clinical audit, which needs future introspection.