A survey study on diabetes management and complication status in primary care setting in Thailand

Healthcare service in Thailand is stratified into three levels with different facilities of care. This cross-sectional survey study described diabetes management, diabetes control, and late complication status among patients managed in urban primary health care clinics.

Thirty-seven primary health care units were randomly selected. Each unit enrolled up to 30 patients having been managed in the unit for at least one year. The patients were interviewed, and the medical records such as demographic data, management practice, glycemic control, and complications were retrospectively reviewed for a period of one year. All data were entered in the case record forms, transferred into a database by electronic scanning, and analyzed by SAS version 6.12. One thousand and seventy-eight patients, including 300 males and 778 females, were recruited in the present study.

Their mean +/- SD of age, onset age, and diabetes duration were 58.2 +/- 11.3, 52.2 +/- 11.4 and 6.2 +/- 4.0 years, respectively. Six percent of the patients were type 1, and 94% were type 2 diabetes. Two-thirds of the patients engaged in diabetes education > or = 5 days during the previous year. Monitoring of glycemic control was largely by measurement of fasting plasma glucose (FPG) in the unit. Determination of hemoglobin A1c (HbA1c), total cholesterol, triglyceride, HDL-cholesterol, serum creatinine, urinary protein, and microalbuminuria were observed in 0.7, 17.4, 11.7, 6.9, 38.2, 33.0, and 0.9% of the patients, respectively. Mean +/- SD of FPG was 8.3 +/- 2.7 mmol/l, and HbA1c was 8.6 +/- 1.9%. The percentage of patients with FPG < 6.7 mmol/l and HbA1c < 7% were 28.7 and 19.6%, respectively. An annual eye and foot examination was performed in 21.5% and 45% of the patients, respectively. The prevalence of late complications included retinopathy (13.6%), proteinuria (17.0%), end stage renal failure (0.1%), peripheral neuropathy (34%), acute foot ulcer/gangrene (1.2%), healed foot ulcer (6.9%), stroke (1.9%), and myocardial infarction (0.7%).

The present study results demonstrated that necessary, routine assessments were not regularly practiced by caregivers in primary care units. In addition, peripheral neuropathy was the most common observed complication and this might explain the high rate of foot ulcers in this cohort.