Five-year change of clinical and complications profile of diabetic patients under the primary health care service across Hong Kong

Abstract

INTRODUCTION The number of Diabetic patients receiving primary care of the Hospital Authority (HA) GOPC rose from 150,157(2009) to 173,015(2013). This study aims to review the recent 5-year changes in epidemiology of diabetic patients. METHOD A cross-sectional study was conducted with information of all diabetic patients under care of HA GOPC retrieved at 2009 and 2013 from HA Clinical Management System. Descriptive statistics were used to show patient’s socio-demographic, clinical parameters, drug usage and major complications. The characteristics comparison between 2009 and 2013 were evaluated by independent t-test for continuous parameters and chi-square for categorical parameters. RESULTS Annual checking of key clinical parameters and data completion rate had been improved significantly. There were significant increases in proportions of patients achieving target HbA1c, SBP, DBP, LDL-C, TG, and HDL-C (p<0.001). Levels of HbA1c, blood pressure (SBP, DBP), LDL-cholesterol (LDL), triglycerides (TG), and BMI dropped significantly from 7.2% to 7.0%, 137.1mmHg to 131.1mmHg, 75.6mmHg to 72.8mmHg, 3.1mmol/L to 2.5mmol/L, 1.7mmol/L to 1.4mmol/L, and 25.7kg/m2 to 25.4kg/m2, respectively. More patients (1.6% raised to 4.0%) used insulin in addition to their oral anti-diabetic drugs for their management, and a significant boost (from 9.0% to 55.7%) on statin use. Prevalence of major DM complications, including cardiovascular diseases (CVD), sight-threatening diabetic retinopathy (STDR), and end-stage renal disease (ESRD) showed significant increase of 0.4% to 2.5%. DISCUSSION Improvement in coverage of annual checking of key clinical parameters and patients’ achievement to target values may be attributed by the regular monitoring and early intervention, including use of appropriate medications, after the launch of the territory-wide Risk Assessment and Management Programme (Diabetes Mellitus) since 2009, with its coverage raised from 3.1% (2009) to 81.9% (2013).