A decade of diabetes care in Taiwan

Abstract

Introduction: Diabetes is a major non-communicable chronic disease with a great impact on health, socio-economic burden, and premature mortality around the world. It has been recognized as an important public health issue for more than two decades in Taiwan, and concerted efforts to improve diabetes care started there in 1990. In facing the challenge of the diabetes burden, the progress and outcomes of diabetes health-care delivery can be studied by reviewing all related statistical data of the past decade.

Methods: Data from annual national vital statistics, periodic surveys and audit reports collected from 2002-2012 in Taiwan were analyzed.

Results: The population growth rate was 0.35%/year, with negative growth in age <40. The highest rate was 6.98%/year in age ≥80 y/o (p <0.001). The number of diabetics receiving any glucose-lowering agent during this period increased from 813,400 to 1,565,300, with an average growth rate of 6.76%/year (p <0.001). The age-specific prevalence rate divided by age group <20 y/o, 20-40 y/o, 40-60 y/o, 60-80 y/o and ≥80 y/o in 2008 was 0.08%, 0.52%, 7.64%, 20.04% and 18.67%, respectively, for men, and 0.08%, 0.80%, 5.70%, 22.44% and 23.63% for women. Accountability measures by age group, including HbA1c (A1C), lipid profile, urine albumin and eye fundus examination, showed a trend towards improvement in 2012 (89.0%, 75.6%, 41.5% and 32.1%, respectively in 2012 (p <0.001). ABC control data from 2002, 2006 and 2011 survey results indicated a trend toward an increased proportion with A1C below 7%, with 22.1%, 34.7% and 40.9%, respectively, in the oral agents group, and 13.7%, 15.4% and 15.8% in the insulin-treated group. BP below 130/80 mmHg was 24.3%, 31.1% and 37.4%, and LDL-C below 100 mg/dl was 29.4%, 33.1% and 51.2%. The premature mortality rate < age 70 y/o decreased from 15.37 to 12.97 per 100,000 from 2002 to 2012 (p = 0.005), and the proportion of premature mortality in diabetes decreased from 36.88% to 29.99% (p <0.001).

Conclusion: Diabetes remains the second highest cause in premature mortality, after cancer, among major non-communicable diseases in Taiwan.

Keywords: ABC control; Accountability; Non-communicable disease (NCD); Premature mortality.