Background: The diagnosis and treatment of diabetes depends on reasonable chronic disease management. Compared with urban areas, county areas are high-risk areas for chronic disease patients, due to the low awareness of chronic disease, poor treatment compliance with chronic disease, low drug persistence, and low cure rate. Therefore, more attention should be paid to chronic disease management in county areas.
Methods: This retrospective, observational study was conducted at the Yun county medical community, Yun county, Yunan province. Data were collected from the medical records of diabetic patients from July 2017 to Aug 2020. The primary outcome variable was the proportion of patients with diabetic complications in county areas. The secondary outcome variables were demographics and clinical characteristics of diabetic patients in county areas, achievement of the HbA1c target, and clinical inertia of diabetic patients in county areas. Comparisons of the simple diabetes group and the diabetic kidney disease (DKD) group in terms of demographics, clinical characteristics, treatment patterns, and health resource consumption were also conducted. A series of appropriate statistical tests were applied to the study population to examine the various outcomes.
Results: A total of 9,721 type 2 diabetic patients were included for the study analysis. Diabetic retinopathy (11.83%), cerebrovascular disease (10.31%), and DKD (9.29%) were the 3 most common complications in overall admissions. Among the 1,347 patients with HbA1c test results, 536 (39.8%) patients achieved the HbA1c target, while 566 (87.62%) of the 661 patients who did not achieve the HbA1c target had clinical inertia during the next 6 months. Compared with simple diabetes patients, patients with DKD had a higher age, wider coverage of medical insurance, and longer duration of diabetes, and were more likely to be complicated with hyperuricemia, dyslipidemia, and hypertension. Regular insulin, metformin, alpha-glucosidase inhibitor, and sulfonylurea were the most widely used antidiabetic drugs in patients with DKD. The health resources consumption also significantly increased.
Conclusions: The proportion of complications in diabetic patients is high in county areas, and blood glucose control is still insufficient. Chronic complications are the key reasons for the decrease in quality of life and high medical costs.
Keywords: China county; Diabetes; chronic disease management; health resource consumption; treatment patterns.