Glycemic control and microvascular complications among type 2 diabetes at primary care units.
OBJECTIVE
To determine the status of disease control and to compare the prevalence of microvascular complications among type-2 diabetes in a primary care setting.


METHODS
The authors performed a cross-sectional study of 287 diabetic patients from 13 primary care units in urban areas of Thailand The status of diabetic control was dominantly defined by HbA(1C) (A1C), blood pressure (BP). Screening programs for microvascular complications included retinopathy and nephropathy. Retinopathy used a seven-field stereoscopic retinal photography while nephropathy was defined by a random urine albumin-to-creatinine ratio.


RESULTS
The AIC of 41.3% of the patients was lower than 7% however 80% of them used only low doses of anti-diabetic drugs. The prevalence of microalbuminuria was 28.7% and macroalbuminuria was 5.7%, whereas diabetic retinopathy was 15.1%. In multivariate analyses, nephropathy was significantly related to duration of diabetes > or =4 years (odds ratio 1.5, 95% CI 1.2-1.8, p < 0.001) and A1C > or =8% (odds ratio 2.2, 95% CI 1.3-3.8, p < 0.05), while retinopathy was related to duration of diabetes > or =4 years (odds ratio 9.5, 95% CI 1.17-77.8, p < 0.05).


CONCLUSIONS
The present study shows that primary care units provides patients with well-controlled diabetes. Nonetheless, those type 2 diabetes patients have significantly higher rates of microvascular complications, despite shorter diabetes duration and lower A1C. Type 2 diabetic patients in primary care unit should be screened for complications and efforts should be done to reach optimal glycemic level, especially for individuals with diabetes > or =4 years.
Mayurasakorn
Korapat
K
Division ofFamily Medicine, Department of Social Medicine, Samutsakhon General Hospital, Samutsakhon, Thailand. drkorapat@hotmail.com
Somthip
Nawarat
N
Caengow
Supak
S
Chulkarat
Nahathai
N
Wanichsuwan
Molee
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000517:prevention & control*; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D013785:Thailand / Q000453:epidemiology
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents