Comparison of HbA1c, blood pressure, and cholesterol (ABC) control in type 2 diabetes attending general medical clinics and specialist diabetes clinics in Thailand

Sieng, Sokha; Thinkamrop, Bandit; Laohasiriwong, Wongsa; Hurst, Cameron

doi:10.1016/j.diabres.2015.02.005

Cited by 10 publications

(12 citation statements)

References 19 publications

(21 reference statements)

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“…By the same token, a low dual goal achievement was also reported recently by others [34,35]. It is of interest that the only study that compared achievement of these goals by primary community based and hospital based clinics did not find significant differences between care providers [30]. Taken together, these reports demonstrate that achievement of ABC goals is low worldwide and most probably represent a common practical reality.…”

Section: Discussionmentioning

confidence: 50%

Achievement of partial combined control of major diabetes targets in primary care correlates with development of chronic complications in T2DM patients—A real life data

Rapoport

Harel

Shasha

et al. 2015

Primary Care Diabetes

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Section: Discussionmentioning

confidence: 50%

Achievement of partial combined control of major diabetes targets in primary care correlates with development of chronic complications in T2DM patients—A real life data

Rapoport

Harel

Shasha

et al. 2015

Primary Care Diabetes

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“…Despite advancement in the treatment of T2DM, optimal glycemic control has not been achieved in almost half of patients in the US [ 2 ] or almost 70% of patients in Thailand [ 3 ]. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are the newest therapeutic option available for the treatment of T2DM which arrived into Thailand market at the end of 2014.…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of diabetes mellitus is growing globally, reaching epidemic proportions along with the worsening of obesity worldwide [ 1 ]. Unfortunately, more than 50–70% of patients with type 2 diabetes mellitus (T2DM) failed to achieve optimal glycemic control [ 2 , 3 ]. While there is ongoing debate whether strict glycemic control could benefit in prevention of macrovascular complications in diabetic patients, the established evidences strongly confirmed suboptimal glycemic control has major consequences on long-term microvascular complications [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of long-term treatment with SGLT2 inhibitors: real-world evidence from a specialized diabetes center

Thewjitcharoen

Yenseung

Malidaeng

et al. 2017

Diabetol Metab Syndr

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BackgroundDiabetes is a progressive disease needing multiple drugs for achieving and maintaining good glycemic control. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) is a novel class of anti-diabetic agent which offers several beneficial effects. However, the long-term effectiveness in clinical practice and safety data of SGLT2 inhibitors is limited, especially in Asian patients. To better understand the effectiveness of SGLT2i in clinical practice, we conducted a retrospective evaluation of patients with diabetes on SGLT2i.MethodsThis retrospective observational study uses data of patients with diabetes who had been prescribed SGLT2i and continued to use at least 6 months at Theptarin Hospital, Bangkok. The characteristics of patients, changes in glycemic control and body weight at 3, 6, 12, 18, 24 months and the last follow-up were evaluated.ResultsA total of 189 patients with diabetes (females 50.3%, mean age 59.9 ± 12.3 years, T2DM 97.3%, duration of diabetes 16.3 ± 9.2 years, baseline BMI 29.9 ± 6.1 kg/m2, baseline HbA1c 8.8 ± 1.6%) were prescribed SGLT2i during the study period. At the time of first SGLT2i prescription, 80.4% used three or more other anti-diabetic agents concomitantly and 34.6% used insulin concomitantly. 151 patients who continue to use at least 6 months were included in analysis. At the last follow-up (median time 16 months), overall median HbA1c reduction and weight reduction were 1.0% and 1.5 kg, respectively. While glycemic control could maintain up to 18 months, weight loss gradually rebounded after the first 6 months and then backed to baseline body weight at 18 months (78.2 ± 18.0 kg vs. 78.0 ± 17.8, p value = 0.324). The incidence of adverse drug reactions of special interest (polyuria, volume depletion-related events, urinary tract infection, genital infection, and hypoglycemia) was 2.1, 1.6, 2.1, 2.6, and 7.9%, respectively.DiscussionThis real-world study confirmed long-term durability of glycemic control with SGLT2i in not only monotherapy, but also add-on studies with other oral anti-diabetic drugs and/or insulin treatment. However, weight loss became evident early after 6 weeks then reached slightly rebounds after 24 weeks until the end of follow-up. Further studies should be done towards a better understanding of treatment with SGLT2i in routine clinical practice.

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“…With the ongoing epidemic of type 2 diabetes, the demand for quality of diabetes care and the need for providing adequate and consistent levels of care require a deeper understanding of the efficacy of existing patients care models. For example, general medical clinic may provide care equivalent to or better than that of specialist diabetes clinic, both in achieving the desired process of care and clinical target, while at the same time, decreasing costs [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

A combination of process of care and clinical target among type 2 diabetes mellitus patients in general medical clinics and specialist diabetes clinics at hospital levels

Sieng

Hurst

2017

BMC Health Serv Res

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BackgroundThis study compares a combination of processes of care and clinical targets among patients with type 2 diabetes mellitus (T2DM) between specialist diabetes clinics (SDCs) and general medical clinics (GMCs), and how differences between these two types of clinics differ with hospital type (community, provincial and regional).MethodsType 2 diabetes mellitus patient medical records were collected from 595 hospitals (499 community, 70 provincial, 26 regional) in Thailand between April 1 to June 30, 2012 resulting in a cross-sectional sample of 26,860 patients. Generalized linear mixed modeling was conducted to examine associations between clinic type and quality of care. The outcome variables of interest were split into clinical targets and process of care. A subsequent subgroup analysis was conducted to examine if the nature of clinical target and process of care differences between GMCs and SDCs varied with hospital type (regional, provincial, community).ResultsRegardless of the types of hospitals (regional, provincial, or community) patients attending SDCs were considerably more likely to have eye and foot exam. In terms of larger hospitals (regional and provincial) patients attending SDCs were more likely to achieve HbA1c exam, All FACE exam, BP target, and the Num7Q. Interestingly, SDCs performed better than GMCs at only provincial hospitals for LDL-C target and the All7Q. Finally, patients with T2DM who attended community hospital-GMCs had a better chance of achieving the blood pressure target than patients who attended community hospital-SDCs.ConclusionsSpecialized diabetes clinics outperform general medical clinics for both regional and provincial hospitals for all quality of care indicators and the number of quality of care indicators achieved was never lower. However, this better performance of SDC was not observed in community hospital. Indeed, GMCs outperformed SDCs for some quality of care indicators in the community level setting.

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Comparison of HbA1c, blood pressure, and cholesterol (ABC) control in type 2 diabetes attending general medical clinics and specialist diabetes clinics in Thailand

Cited by 10 publications

References 19 publications

Achievement of partial combined control of major diabetes targets in primary care correlates with development of chronic complications in T2DM patients—A real life data

Achievement of partial combined control of major diabetes targets in primary care correlates with development of chronic complications in T2DM patients—A real life data

Effectiveness of long-term treatment with SGLT2 inhibitors: real-world evidence from a specialized diabetes center

A combination of process of care and clinical target among type 2 diabetes mellitus patients in general medical clinics and specialist diabetes clinics at hospital levels

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