Effectiveness of quality of care for patients with type 2 diabetes in China: findings from the Shanghai Integration Model (SIM)

Abstract

This cross-sectional study aimed to investigate the quality of care of diabetes in Shanghai, China. A total of 173 235 patients with type 2 diabetes in 2017 were included in the analysis. Profiles of risk factors and intermediate outcomes were determined. The patients had a mean age of 66.43±8.12 (standard deviation (SD)) years and a mean diabetes duration of 7.95±5.53 (SD) years. The percentage of patients who achieved the target level for HbA_1c (<7.0%) was 48.6%. Patients who achieved the target levels for blood pressure (BP)<130/80 mmHg and low-density lipoprotein-cholesterol (LDL-c)<2.6 mmol/L reached 17.5% and 34.0%, respectively. A total of 3.8% achieved all three target levels, and the value increased to 6.8% with an adaptation of the BP target level (<140/90 mmHg) for those over 65 years. Multivariable analysis identified the factors associated with a great likelihood of achieving all three target levels: male, young age, short diabetes duration, low body mass index, macrovascular complications, no microvascular complications, prescribed with lipid-lowering medication, and no prescription of antihypertensive medication. In conclusion, nearly 50% and one-third of the patients with diabetes met the target levels for HbA_1c and LDL-c, respectively, with a low percentage achieving the BP target level. The percentage of patients who achieved all three target levels needs significant improvement.

Keywords

type 2 diabetes / quality of care / macrovascular complication / microvascular complication / treatment pattern / epidemiology

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Acknowledgements

We thank all the study participants for their contributions and appreciate the contributions made by all 240 CHCs of 16 districts and the Shanghai Municipal Government for funding support. This project was supported by the Shanghai Municipal Government Grants Award (No. GWIV-3), the Shanghai Health Policy Grant (No. 2019HP49), the Shanghai Health Commission Grant (No. 20194Y0141), the Shanghai Jiao Tong University Grant (No. CHDI-2018-A-05), the Shanghai Public Health Youth Award (No. GWV-10.2-YQ24), and the Three-Year Action Program of Shanghai Municipality for Strengthening the Construction of Public Health System (No. GWV-10.1-XK05).

Compliance with ethics guidelines

Chun Cai, Yuexing Liu, Yanyun Li, Yan Shi, Haidong Zou, Yuqian Bao, Yun Shen, Xin Cui, Chen Fu, Weiping Jia, and the SIM Study Group declare that they have no conflicts of interest. All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

Electronic Supplementary Material

Supplementary material is available in the online version of this article at https://doi.org/10.1007/s11684-021-0897-7 and is accessible for authorized users.

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