title: Role of an outpatient clinic in screening chronic complications of diabetes: a model for diabetes managed care.
abstract: The purpose of this study was to evaluate the need for an outpatient clinic for screening chronic complications of diabetes mellitus and to explore the major risk factors for such complications. A total of 558 patients (293 men and 265 women, aged 61.4 +/- 10.0 yr) with non-insulin-dependent diabetes mellitus were recruited. All examinations were performed in all patients except for those with previously known complications. A nonmydriatic fundus camera was used to detect retinopathy. Microalbuminuria was detected with a semiquantitative method. A monofilament, semiquantitative tuning fork and neurometer were used to detect peripheral neuropathy. The relationships of demographic and metabolic factors with diabetic complications were analyzed. Among the 558 patients, 443 (79.3%) were found to have at least one chronic complication. Less than half (41.5%) of patients had been identified as having a complication(s) before screening. The rates of undiagnosed complications ranged from 46.7% to 83.4% for each complication. The duration of diabetes, hemoglobin A1c (HbA1c), and systolic blood pressure (BP) were strongly associated with microvascular complications (p = 0.009, 0.018 and 0.037, respectively). The microvascular complication rates reached a plateau when HbA1c reached 8.0% at least among patients with a systolic BP of less than 130 mmHg. Our findings indicate that undiagnosed complications (average, 58.5%) can be found with routine screening, increasing the chances for prompt attention and early intervention. The duration of diabetes, HbA1c, and systolic BP were strongly associated with microvascular complications. Diabetes care can be improved by the implementation of a screening clinic in daily practice. Identification of the specific risk factors in a defined population in specific clinical settings will allow early modification of interventions for optimal diabetes care.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Y D
authors.initials: YD
authors.lastname: Jiang
authors.forename: L M
authors.initials: LM
authors.lastname: Chuang
authors.forename: H P
authors.initials: HP
authors.lastname: Wu
authors.forename: T Y
authors.initials: TY
authors.lastname: Tai
authors.forename: B J
authors.initials: BJ
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D048909:Diabetes Complications; D003925:Diabetic Angiopathies / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D012307:Risk Factors