Comparison of HbA1c, blood pressure, and cholesterol (ABC) control in type 2 diabetes attending general medical clinics and specialist diabetes clinics in Thailand.
OBJECTIVE
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.
Faculty of Public Health, Khon Kaen University, Thailand; Ministry of Education, Youth and Sport, Cambodia.
Sokha
S
Sieng
Faculty of Public Health, Khon Kaen University, Thailand.
Bandit
B
Thinkamrop
Faculty of Public Health, Khon Kaen University, Thailand.
Wongsa
W
Laohasiriwong
Faculty of Public Health, Khon Kaen University, Thailand. Electronic address: cphurst@gmail.com.
Cameron
C
Hurst
D000368:Aged; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D001794:Blood Pressure; D001795:Blood Pressure Determination; D002784:Cholesterol / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006769:Hospitals, General / Q000706:statistics & numerical data; D006782:Hospitals, Special / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013785:Thailand
D002784:Cholesterol; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
ABC goals; General medical clinics; Specialist diabetes clinics; Type 2 diabetes