[Prevalence of diabetes, antidiabetic treatment and chronic diabetic complications reported by general practitioners].
BACKGROUND
Prevalence of type 2 diabetes has increased greatly over the past decade and focus of care for people with diabetes has shifted from specialists to general practitioners (GPs). Because of lack of the central registry, a real number of diagnosed diabetes in Poland is unknown, as unknown is the prevalence of diabetes in patients attending primary health care, provided treatment and a prevalence of chronic diabetic complications registered by GPs.


OBJECTIVE
Assessment of the prevalence of diabetes registered in primary health care, recommended antidiabetic treatment and prevalence of microangiopathic diabetic complications diagnosed by GPs.


METHODS
Study was performed in Szczecin, a city of 450 000 inhabitants, located in North-West part of Poland. Data were obtained in year 2002 from one of the primary health care centers, in which health care was provided by 12 GPs for 27 932 inhabitants (15655 females and 12277 males), aged 0-98 years (average 38.3 +/- 23.2 years). Data were extracted from medical records and provided by GP doctors.


RESULTS
Number of diagnosed and registered diabetics was 993 (prevalence--3.56%), age 3-95 years (mean 65.4 +/- 13.6 years). The diabetic group consisted of 611 females (mean age 67.5 +/- 12.4)--prevalence--3.90% and 382 males (mean age 62.0 +/- 14.7)--prevalence--3.11% (p = 0.003). Mean duration of diabetes was 7.4 +/- 6.9 years and it was similar for males and females. Type 2 diabetes was diagnosed in 94.4%, type 1 diabetes in 4.5%, other types of diabetes in 1.1% of all patients. Prevalence of registered diabetes in the group of 0-10 years old was 0.08%, in the group 11-20 years--0.33%, 21-30 years--0.25%, 31-40 years--0.44%, 41-50 years--1.93%, 51-60 years--5.03%, 61-70 years--9.88% and in the group over 70 years old--14.37%. Prevalence of diabetes in the group over 14 years old was 4.38%, in the group over 20 years--4.86%, and in subjects older than 35 years--6.84%. Elderly patients, over 60 years account for 74% of all diabetic subjects and subjects over 70 years--for 45% of them. Reported treatment of type 2 diabetes: diet alone--9%, oral agents--68%, oral agents combined with insulin--10.5%, insulin alone--12.5%. Mean HbA1c value measured in 307 type 2 diabetic subjects was 7.25 +/- 1.28%. According to GPs' opinion chronic microangiopathic diabetes complications were present in 36.6% of type 2 diabetic subjects. Retinopathy was reported in 24.8% of patients, polyneuropathy in 2.4%, nephropathy in 1.5%, diabetic foot in 0.5%, and combination of different complications in 7.4% of them. In type 1 diabetes chronic diabetic complications were stated in 42.2% of subjects--retinopathy--in 15.6%, polyneuropathy--in 2.2%, nephropathy--in 2.2%, diabetic foot--in 2.2%, and combination of them--in 20.0%. Average number of registered diabetics was 83 per physician, however 6 doctors took care of 107-158 diabetic subjects. In the past year diabetologist consultation or hospitalisation in internal medicine unit was provided for 47% of type 2 diabetics and for 98% of type 1 diabetics.


CONCLUSIONS
1. The prevalence of diabetes registered in primary health care in Szczecin is higher than expected on the basis of European data. 2. Low number of type 2 diabetics is treated with diet alone and quite high number is treated with insulin. 3. Low number of chronic diabetic complications reported by GPs, despite long duration of disease, indicates the necessity of special training in delivering care for diabetic people, diagnosis of diabetic complications, increased access to secondary care and better cooperation between primary and secondary care.
Fabian
Wiesława
W
NZOZ Przychodnia Medycyny Rodzinnej w Szczecinie.
Majkowska
Liliana
L
Stefański
Adam
A
Moleda
Piotr
P
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D048909:Diabetes Complications / Q000453:epidemiology* / Q000209:etiology; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000453:epidemiology*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000453:epidemiology; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D011044:Poland / Q000453:epidemiology; D015995:Prevalence; D012042:Registries; D012307:Risk Factors; D017678:Sex Distribution
D007004:Hypoglycemic Agents