TY - JOUR
T1 - Type 1 diabetes mellitus care and education in China
T2 - The 3C study of coverage, cost, and care in Beijing and Shantou
AU - McGuire, Helen C
AU - Ji, Linong
AU - Kissimova-Skarbek, Katarzyna
AU - Whiting, David
AU - Aguirre, Florencia
AU - Zhang, Puhong
AU - Lin, Shaoda
AU - Gong, Chunxiu
AU - Zhao, Weigang
AU - Lu, Juming
AU - Guo, Xiaohui
AU - Ji, Ying
AU - Seuring, Till
AU - Hong, Tianpei
AU - Chen, Lishu
AU - Weng, Jianping
AU - Zhou, Zhiguang
N1 - Copyright © 2017. Published by Elsevier B.V.
PY - 2017/7
Y1 - 2017/7
N2 - AIMS: The paucity of data on Type 1 diabetes in China hinders progress in care and policy-making. This study compares Type 1 diabetes care and clinical outcomes in Beijing and Shantou with current clinical guidelines.METHODS: The 3C Study was a cross-sectional study of the clinical practices and outcomes of people with Type 1 diabetes. The study sequentially enrolled 849 participants from hospital records, inpatient wards, and outpatient clinics. Data were collected via face-to-face interviews with patients and health professionals, the Summary of Diabetes Self-Care Activities, medical records, and venous blood samples. Care was audited using ISPAD/IDF indicators. Data underwent descriptive analysis and tests for association.RESULTS: The median age was 22years (IQR=13-34years), and 48.4% of the sample had diabetes less than six years. The median HbA1c was 8.5% (69mmol/mol) (IQR 7.2-10.5%), with significant regional variance (p=0.002). Insulin treatment was predominantly two injections/day (45% of patients). The highest incidence of diabetic ketoacidosis was 14.4 events/100 patient years among adolescents. Of the 57.3% of patients with LDL-C>2.6mmol/L, only 11.2% received treatment. Of the 10.6% considered hypertensive, 47.1% received treatment. Rates of documented screening for retinopathy, nephropathy, and peripheral neuropathy were 35.2%, 42.3%, and 25.0%, respectively. The median number of days of self-monitoring/week was 3.0 (IQR=1.0-7.0). There were significant differences in care practices across regions.CONCLUSIONS: The study documented an overall deficit in care with significant regional differences noted compared to practice guidelines. Modifications to treatment modalities and the structure of care may improve outcomes.
AB - AIMS: The paucity of data on Type 1 diabetes in China hinders progress in care and policy-making. This study compares Type 1 diabetes care and clinical outcomes in Beijing and Shantou with current clinical guidelines.METHODS: The 3C Study was a cross-sectional study of the clinical practices and outcomes of people with Type 1 diabetes. The study sequentially enrolled 849 participants from hospital records, inpatient wards, and outpatient clinics. Data were collected via face-to-face interviews with patients and health professionals, the Summary of Diabetes Self-Care Activities, medical records, and venous blood samples. Care was audited using ISPAD/IDF indicators. Data underwent descriptive analysis and tests for association.RESULTS: The median age was 22years (IQR=13-34years), and 48.4% of the sample had diabetes less than six years. The median HbA1c was 8.5% (69mmol/mol) (IQR 7.2-10.5%), with significant regional variance (p=0.002). Insulin treatment was predominantly two injections/day (45% of patients). The highest incidence of diabetic ketoacidosis was 14.4 events/100 patient years among adolescents. Of the 57.3% of patients with LDL-C>2.6mmol/L, only 11.2% received treatment. Of the 10.6% considered hypertensive, 47.1% received treatment. Rates of documented screening for retinopathy, nephropathy, and peripheral neuropathy were 35.2%, 42.3%, and 25.0%, respectively. The median number of days of self-monitoring/week was 3.0 (IQR=1.0-7.0). There were significant differences in care practices across regions.CONCLUSIONS: The study documented an overall deficit in care with significant regional differences noted compared to practice guidelines. Modifications to treatment modalities and the structure of care may improve outcomes.
KW - Adolescent
KW - Adult
KW - Beijing/epidemiology
KW - Cost of Illness
KW - Cross-Sectional Studies
KW - Diabetes Mellitus, Type 1/drug therapy
KW - Diabetes Mellitus, Type 2/drug therapy
KW - Diabetic Ketoacidosis/drug therapy
KW - Female
KW - Humans
KW - Insulin/therapeutic use
KW - Insurance Coverage
KW - Insurance, Health
KW - Male
KW - Self Care
KW - Young Adult
U2 - 10.1016/j.diabres.2017.02.027
DO - 10.1016/j.diabres.2017.02.027
M3 - Article
C2 - 28500868
SN - 0168-8227
VL - 129
SP - 32
EP - 42
JO - Diabetes Research and Clinical Practice
JF - Diabetes Research and Clinical Practice
ER -