Zhongguo quanke yixue (Mar 2022)
A Real-world Data Study on Comprehensive Control Rates in a Large Population of Type 2 Diabetes Patients
Abstract
BackgroundThere are differences between RCTs and real-world data in reporting the rate of clinical control of patients with diabetes, which cannot solve the problem of continuous observation in large-scale populations. At present, there is no real-world data cross-sectional survey research and related literature of clinical control indicators of T2DM patients who avoid direct contact with patients and doctors in China.ObjectiveTo explore the clinical control compliance rate of individual and comprehensive indicators in patients with type 2 diabetes mellitus (T2DM) in the real world.MethodsSince 2017, 13 community health service institutions in Wuhou District that have gradually bound the data of the primary care information business system to the EPM through unique ID information were selected as sample areas. T2DM patients with EPM bound in the sample area were selected as the research subjects. The effective follow-up period, within 1 year outside the effective follow-up period, and more than 1 year outside the effective follow-up period of T2DM patients with glycated hemoglobin (HbA1c) , low-density lipoprotein cholesterol (LDL-C) , blood pressure follow-up rate, average level, and clinical control compliance rate were recorded. The follow-up rate of comprehensive indicators of 3B (ie HbA1c, LDL-C, blood pressure) and the rate of clinical control compliance were recorded. The correlation between HbA1c, LDL-C, blood pressure, 3B comprehensive indicators and the number of T2DM patients managed in different community health service institutions, the correlation between the number of patients with HbA1c, LDL-C, blood pressure and the effect of each indicator during the effective follow-up period sex were analyzed.ResultsAmong the 26 501 contracted T2DM patients, the follow-up rates of HbA1c, LDL-C, blood pressure and 3B comprehensive indicators during the effective follow-up period were 43.54% (11 539/26 501) , 45.66% (12 101/26 501) , 89.18% (23 633/26 501) and 32.89% (8 715/26 501) , respectively. The follow-up rates of HbA1c, LDL-C, blood pressure and 3B composite indicators within 1 year outside the effective follow-up period were 15.81% (4 190/26 501) , 24.02 % (6 366/ 26 501) , 9.29 (2 463/26 501) and 0.97% (257/26 501) respectively. The follow-up rates of HbA1c, LDL-C, blood pressure and 3B comprehensive indicators beyond the effective follow-up period for more than 1 year were 19.20% (5 087/26 501) , 23.41% (6 203/26 501) , 1.28% (339/26 501) and 0.49% (131/26 501) , respectively. During the effective follow-up period, the clinical control rates of HbA1c, LDL-C, blood pressure and 3B comprehensive indicators were 60.79% (7 015/11 539) , 59.74% (7 229/12 101) , 52.57% (12 423/23 633) and 18.75% (1 634/8 715) , respectively. The clinical control rate of HbA1c, LDL-C, blood pressure, and 3B comprehensive indicators within 1 year outside the effective follow-up period were 51.98% (2 178/4 190) , 56.75% (3 613/6 366) , 47.79% (1 177/2 463) and 14.79% (38/257) , respectively. The clinical control rates of HbA1c, LDL-C and blood pressure beyond the effective follow-up period for more than 1 year were 65.62% (3 338/5 087) , 59.46% (3 688/6 203) and 22.71% (77/339) , respectively. There was a high correlation between the blood pressure clinical control compliance rate and the 3B comprehensive index clinical control compliance rate (r=0.949, P<0.01) . HbA1c (r=0.648) , LDL-C (r=0.867) , blood pressure (r=0.988) , and the number of 3B comprehensive indicators (r=0.712) were positively correlated with the number of T2DM patients managed in different community health service institutions within the validity period (P<0.05) . The mean LDL-C was negatively correlated with the number of managed cases of T2DM patients (r=-0.715, P<0.01) , and the number of clinically controlled cases (r=0.888) and the rate of clinically controlled compliance (r=0.704) were positively correlated with the number of managed cases of T2DM patients (P<0.05) . Blood pressure (r=0.791) , the number of clinically controlled cases of 3B comprehensive indicators (r=0.616) were positively correlated with the number of managed cases of T2DM patients (P<0.05) . The standard deviation of HbA1c was negatively correlated with the number of HbA1c follow-up cases within the validity period (r=-0.708, P<0.01) , and the number of clinically controlled cases was positively correlated with the number of HbA1c follow-up cases within the validity period (r=0.943, P<0.01) . The average LDL-C value was negatively correlated with the number of LDL-C follow-up cases within the validity period (r=-0.716, P<0.01) , and the number of clinically controlled cases and the clinical control compliance rate were positively correlated with the number of LDL-C follow-up cases within the validity period (r=0.986, r=0.657, P<0.05) . There was a positive correlation between the number of blood pressure clinical control patients and the number of blood pressure follow-up cases within the validity period (r=0.839, P< 0.01) .ConclusionThe individual and comprehensive control levels and control rates of 3B indicators in sample areas are higher, and the differences among institutions are small. The service quality of district as a unit is highly balanced, but there is still a large space for improvement of evidence-based management behavior of lost population.
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