Treatment of type 2 diabetes mellitus in a primary care setting in Taiwan: Comparison with secondary/tertiary care

Background: This study investigated the status of diabetes control and management in patients treated in a primary healthcare setting and compared the results with data previously obtained for secondary/tertiary care patients in Taiwan. Methods: This study was conducted at 51 primary healthcare stations randomly selected island-wide in Taiwan in 2001. A total of 1302 type 2 diabetes patients who had been followed-up for more than I year were included. Blood was collected for centralized HbA(1c) assay. The remaining data and information were collected by review of medical records and patient interview. Results: Compared with the results of a previous study on patients treated in a secondary/tertiary care setting, a significantly smaller percentage of primary care patients were receiving insulin therapy. Primary care patients also had a shorter duration of diabetes, a higher HbA(1c) level, better blood pressure control and a lower prevalence of complications. The proportion of patients achieving optimal control of glycemia and blood pressure was low. Patients aged < 65 years had a significantly shorter duration of diabetes, poorer diabetes control and better blood pressure control than elderly patients aged >= 65 years. Primary care patients aged >= 65 years had a significantly higher frequency of stroke than those aged < 65 years. The elderly group of secondary/tertiary care patients had a significantly higher frequency of coronary heart disease and stroke. Duration of diabetes and hypertension were the leading risk factors for complications in diabetes patients treated in both primary and secondary/tertiary care settings. Conclusion: Diabetes control was poorer in primary care than in seconclary/tertiary care patients, but control of blood pressure was better in primary care patients. The shorter duration of diabetes and better control of blood pressure in primary care patients and in patients aged < 65 years compared with their elderly counterparts might be related to a lower prevalence of complications.