Five-year change of clinical and complications profile of diabetic patients under primary care: a population-based longitudinal study on 127,977 diabetic patients

Abstract

BackgroundNumber of diabetic patients under public primary care in Hong Kong rose from 150,157 (2009) to 173,015 (2013). This study aimed to track the 5-year change of their outcomes and care standard after the introduction of quality enhancement programmes.MethodsLongitudinal study was conducted on a group of diabetic patients who received continuous care under public primary care between 2009 and 2013. Socio-demographic and clinical data was retrieved from central database. The standard of care in terms of proportion of patients achieving haemoglobin A1c (HbA1c), systolic and diastolic blood pressure (SBP and DBP), and low density lipoprotein-cholesterol (LDL-C) target levels, mean parameter changes, and 5-year cumulative incidence of major complications were assessed. Outcomes between 2009 and 2013 were compared by McNemar’s test for proportion of patients treated to targets and paired t-test for continuous outcome parameters.ResultsA group of 127,977 diabetic patients who had continuous follow-up between 2009 and 2013 were assessed. A significantly higher proportions of patients achieving targets of HbA1c (<7 %), SBP (<130 mmHg), DBP (<80 mmHg), LDL-C (<2.6 mmol/L), triglyceride (<1.7 mmol/L), and high density lipoprotein-cholesterol (>1.0 or 1.3 mmol/L) were observed (p < 0.001). There was a significant drop in the mean values of HbA1c (7.2–7.0 %), SBP (136.9–131.3 mmHg), DBP (75.4–72.1 mmHg), LDL-C (3.1–2.4 mmol/L), triglyceride (1.7–1.4 mmol/L), and body mass index (25.6–25.3 kg/m2). More patients (0.6 % raised to 3.5 %) used insulin in addition to their oral anti-diabetic drugs for their management, and a significant boost (from 9.0 to 55.0 %) was on statin use. 5-year cumulative incidence of any major diabetic complication was 6.2 %.ConclusionsStandard of public primary care for diabetic patients enhanced from 2009 to 2013, as reflected by the improvement in outcomes of care. It could be related to the implementation of the territory-wide quality enhancement programmes in all public primary care clinics since 2009, with coverage increasing from 3.1 % (2009) to 81.9 % (2013).Clinical trial number and registry: NCT02034695, ClinicalTrials.govElectronic supplementary materialThe online version of this article (doi:10.1186/s13098-015-0072-x) contains supplementary material, which is available to authorized users.

Temporal trends in quality of primary care for patients with type 2 diabetes mellitus: A population‐based retrospective cohort study after implementation of a quality improvement initiative

“…Enrolment to RAMP‐DM and PEP was referred through physicians and nurses at general outpatient clinics. Across a 5‐year time frame, there was a substantial increase in the coverage rate of RAMP‐DM (from 2.7% in 2009 to 81.9% in 2013) and PEP (from 2.1% in 2010 to 13.4% in 2013) interventions, most of T2D patients (82.4%) enrolling 1 of the interventions under quality improvement initiative at the end.…”

Insulin-like growth factor-1 promotes the proliferation and odontoblastic differentiation of human dental pulp cells under high glucose conditions

“…The number of individuals with DM is expected to increase to almost 592 million by the year 2035 (11). DM may lead to numerous complications, including cardiovascular diseases, microvascular diseases (such as diabetic retinopathy), osteoporosis and diabetic nephropathy (12,13). Additionally, DM also affects the functions of dental pulp and periapical tissues (14,15).…”

Evolution of Diabetes Care in Hong Kong: From the Hong Kong Diabetes Register to JADE-PEARL Program to RAMP and PEP Program

“…Since the implementation of the RAMP-DM program in the public primary care clinics in Hong Kong, there had been a significant increase in the use of disease-modifying drugs, especially statins (from 9% to 55%) between 2009 and 2013 ( Table 3 ) [ 49 ]. In an analysis comparing the 2000 to 2002 and 2010 to 2012 cohorts of T2DM patients followed up at primary care clinics, more patients achieved any one of the three treatment targets (32.9% vs. 50% for HbA1c less than 7%; 24.7% vs. 30.7% for BP less than 130/80 mm Hg; 25.8% vs. 38.1% for LDL-C less than 2.6 mmol/L), with reduction in all DM-related complications and death [ 50 ].…”

“…In an analysis comparing the 2000 to 2002 and 2010 to 2012 cohorts of T2DM patients followed up at primary care clinics, more patients achieved any one of the three treatment targets (32.9% vs. 50% for HbA1c less than 7%; 24.7% vs. 30.7% for BP less than 130/80 mm Hg; 25.8% vs. 38.1% for LDL-C less than 2.6 mmol/L), with reduction in all DM-related complications and death [ 50 ]. This improvement remained significant after adjustment for disease duration, likely reflecting the more prevalent use of organ protective drugs, as well as enhanced accessibility to complication screening (from 3.1% to 81.9%) [ 49 ]. However, the little improvement in albuminuria (23% vs. 26.3%) and central obesity (77.1% vs. 81.3%) called for further efforts to control these risk factors ( Table 3 ).…”