Chew B H, Shariff-Ghazali S, Lee P Y, Cheong A T, Mastura I, Haniff J, Bujang M A, Taher S W, Mustapha F I
Universiti Putra Malaysia, Faculty of Medicine & Health Sciences, Department of Family Medicine, Serdang, Selangor, Malaysia.
Institute of Gerontology, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
Med J Malaysia. 2013 Oct;68(5):397-404.
Diabetes care at different healthcare facilities varied from significantly better at one setting to no difference amongst them. We examined type 2 diabetes patient profiles, disease control and complication rates at four public health facilities in Malaysia.
This study analyzed data from diabetes registry database, the Adult Diabetes Control and Management (ADCM). The four public health facilities were hospital with specialist (HS), hospital without specialist (HNS), health clinics with family physicians (CS) and health clinic without doctor (CND). Independent risk factors were identified using multivariate regression analyses.
The means age and duration of diabetes in years were significantly older and longer in HS (ANOVA, p< 0.0001). There were significantly more patients on insulin (31.2%), anti-hypertensives (80.1%), statins (68.1%) and antiplatelets (51.2%) in HS. Patients at HS had significantly lower means BMI, HbA1c, LDL-C and higher mean HDL-C. A significant larger proportion of type 2 diabetes patients at HS had diabetes-related complications (2-5 times). Compared to the HS, the CS was more likely to achieve HbA1c ≤ 6.5% (adjusted OR 1.2) and BP target < 130/80 mmHg (adjusted OR 1.4), the HNS was 3.4 times more likely not achieving LDL-C target < 2.6 mmol/L.
Public hospitals with specialists in Malaysia were treating older male Chinese type 2 diabetes patients with more complications, and prescribed more medications. Patients attending these hospitals achieved better LDL-C target but poorer in attaining BP and lower HbA1c targets as compared to public health clinics with doctors and family physicians.
不同医疗机构的糖尿病护理水平差异很大，从一种环境下明显更好到各机构之间没有差异。我们研究了马来西亚四家公共卫生机构中2型糖尿病患者的概况、疾病控制情况和并发症发生率。
本研究分析了糖尿病登记数据库“成人糖尿病控制与管理”（ADCM）中的数据。这四家公共卫生机构分别是有专科医生的医院（HS）、没有专科医生的医院（HNS）、有家庭医生的健康诊所（CS）和没有医生的健康诊所（CND）。使用多变量回归分析确定独立危险因素。
HS组患者的平均年龄和糖尿病病程在年数上显著更大和更长（方差分析，p<0.0001）。HS组使用胰岛素（31.2%）、抗高血压药（80.1%）、他汀类药物（68.1%）和抗血小板药物（51.2%）的患者明显更多。HS组患者的平均BMI、糖化血红蛋白、低密度脂蛋白胆固醇显著更低，高密度脂蛋白胆固醇平均更高。HS组中2型糖尿病患者发生糖尿病相关并发症的比例显著更高（2至5倍）。与HS组相比，CS组更有可能实现糖化血红蛋白≤6.5%（调整后OR为1.2）和血压目标<130/80 mmHg（调整后OR为1.4），HNS组未达到低密度脂蛋白胆固醇目标<2.6 mmol/L的可能性高3.4倍。
马来西亚有专科医生的公立医院治疗的2型糖尿病老年男性患者并发症更多，且开的药更多。与有医生和家庭医生的公共卫生诊所相比，在这些医院就诊的患者低密度脂蛋白胆固醇目标实现得更好，但血压和糖化血红蛋白目标实现得较差。
