Comparison of HbA1c, blood pressure, and cholesterol (ABC) control in type 2 diabetes attending general medical clinics and specialist diabetes clinics in Thailand.

Autor: Sieng S; Faculty of Public Health, Khon Kaen University, Thailand; Ministry of Education, Youth and Sport, Cambodia., Thinkamrop B; Faculty of Public Health, Khon Kaen University, Thailand., Laohasiriwong W; Faculty of Public Health, Khon Kaen University, Thailand., Hurst C; Faculty of Public Health, Khon Kaen University, Thailand. Electronic address: cphurst@gmail.com.
Jazyk: angličtina
Zdroj: Diabetes research and clinical practice [Diabetes Res Clin Pract] 2015 May; Vol. 108 (2), pp. 265-72. Date of Electronic Publication: 2015 Feb 16.
DOI: 10.1016/j.diabres.2015.02.005
Abstrakt: Aims: The aim of this study was to compare the achievement of clinical targets for patients with type 2 diabetes mellitus (T2DM) in general medical clinics (GMCs) and specialist diabetes clinics (SDCs) for different hospital types (regional, provincial and community) in Thailand.
Methods: We used the medical records of patients (n=26,860) with T2DM from 595 hospitals (26 regional, 70 provincial and 499 community) across all 77 provinces in Thailand. Generalized linear mixed models were used to conduct multi-level modeling to evaluate the achievement of individual outcomes (A - glycated hemoglobin (HbA1c) <7.0% (53 mmol/mol), B - Blood Pressure (BP) <140/80 mmHg and C - LDL-Cholesterol <100mg/dL) and aggregated outcomes (AllABC - achieved all three of the targets, AnyABC - achieved at least one target, ABCcount - the number of targets achieved: 0, 1, 2 or 3).
Results: Neither clinic types (SDCs or GMCs) were consistency superior across all hospital types. For regional hospitals, SDCs were associated with higher odds of achieving BP, AnyABC, and ABCcount (OR=1.55, 95%CI: 1.25-1.92, p<0.001; OR=1.35, 95%CI: 1.02-1.79; p=0.04; RR=1.10, 95%CI: 1.01-1.20, p=0.03, respectively). For provincial hospitals, SDCs exhibited higher achievement of BP and LDL-C (OR=1.52, 95%CI: 1.23-1.87, p<0.001; OR=1.28, 95%CI: 1.04-1.58, p=0.02, respectively). For community hospitals, however GMCs demonstrated higher achievement of BP and AnyABC (OR=0.81, 95%CI: 0.67-0.98, p=0.03; OR=0.74, 95%CI: 0.56-0.97, p=0.03, respectively).
Conclusions: In larger (regional and provincial) hospitals, SDCs outperform GMCs in several (but not all) clinical targets. In contrast, in community hospital, where most patients with T2DM are serviced, GMCs were shown to have superior performance.
(Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)
Databáze: MEDLINE
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