Glycemic control and microvascular complications among type 2 diabetes at primary care units

Objective: To determine the status of disease control and to compare the prevalence of microvascular complications among type-2 diabetes in a primary care setting. Material and Method: The authors performed a cross-sectional study of 287 diabetic patients from 13 primary care units in urban areas of Thailand. The status of diabetic control was dominantly defined by HbA1C (A1C), blood pressure (BP). Screening programs for microvascular complications included retinopathy and nephropathy. Retinopathy used a seven-field stereoscopic retinal photography while nephropathy was defined by a random urine albumin-to-creatinine ratio. Results: The A1C of 41.3% of the patients was lower than 7% however, 80% of them used only low doses of anti-diabetic drugs. The prevalence of microalbuminuria was 28.7% and macroalbuminuria was 5.7%, whereas diabetic retinopathy was 15.1%. In multivariate analyses, nephropathy was significantly related to duration of diabetes ≥ 4 years (odds ratio 1.5, 95% CI 1.2-1.8, p < 0.001) and A1C ≥ 8% (odds ratio 2.2, 95% CI 1.3-3.8, p < 0.05), while retinopathy was related to duration of diabetes ≥ 4 years (odds ratio 9.5, 95% CI 1.17-77.8, p < 0.05). Conclusion: The present study shows that primary care units provides patients with well-controlled diabetes. Nonetheless, those type 2 diabetes patients have significantly higher rates of microvascular complications, despite shorter diabetes duration and lower A1C. Type 2 diabetic patients in primary care unit should be screened for complications and efforts should be done to reach optimal glycemic level, especially for individuals with diabetes ≥ 4 years.