Yoo Kyoung-Hun, Shin Dong-Wook, Cho Mi-Hee, Kim Sang-Hyuck, Bahk Hyun-Jung, Kim Shin-Hye, Jeong Su-Min, Yun Jae-Moon, Park Jin-Ho, Kim Heesun, Cho BeLong
Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Republic of Korea.
Department of Family Medicine/Supportive Care Center, Samsung Medical Center, Republic of Korea.
Diabetes Res Clin Pract. 2017 Sep;131:61-69. doi: 10.1016/j.diabres.2017.06.008. Epub 2017 Jun 23.
Suboptimal frequency of glycosylated hemoglobin (HbA1c) monitoring is associated with poor diabetes control. We aimed to analyze compliance to HbA1c testing guidelines and explore associated individual and area-level determinants, focusing on regional variation.
This cross-sectional study between the period of 2012-2013 was conducted by using the Korean National Health Insurance Research Database, and included 45,634 patients diagnosed with diabetes mellitus, who were prescribed any anti-diabetic medications, including insulin. We calculated the proportion of each HbA1c testing frequency (≥1, ≥2, or ≥4 times per year) stratified by 17 administrative regions. Multilevel and multivariate logistic analyses were performed with regional (proportion of farmer population) and individual characteristics (age, sex, income level, duration of diabetes, and most visited medical institution).
Overall, 67.3% of the patients received≥1 HbA1c test per year; 37.8% and 6.1% received ≥2 and ≥4 tests per year, respectively. Those managed in secondary-level hospitals or clinics and those living in rural areas were less likely to receive HbA1c testing. Even after adjusting for individual and regional level characteristics, significant area level variation was observed (variance participant coefficients were 7.91%, 9.58%, and 14.43% for testing frequencies of ≥1, ≥2, and ≥4 times a year, respectively).
The frequency of HbA1c monitoring is suboptimal in Korea, especially in rural areas. Moreover, significant regional variation was observed, implying a contextual effect. This suggests the need for developing policy actions to improve HbA1c monitoring. In particular, access to HbA1c testing in rural primary care clinics must be improved.
糖化血红蛋白（HbA1c）监测频率未达最佳与糖尿病控制不佳相关。我们旨在分析对HbA1c检测指南的依从性，并探讨相关的个体和地区层面的决定因素，重点关注地区差异。
本横断面研究利用韩国国民健康保险研究数据库在2012年至2013年期间进行，纳入了45634例被诊断为糖尿病且开具了包括胰岛素在内的任何抗糖尿病药物处方的患者。我们计算了按17个行政区分层的每种HbA1c检测频率（每年≥1次、≥2次或≥4次）的比例。采用多水平和多变量逻辑分析，分析地区特征（农民人口比例）和个体特征（年龄、性别、收入水平、糖尿病病程以及就诊最多的医疗机构）。
总体而言，67.3%的患者每年接受≥1次HbA1c检测；每年接受≥2次和≥4次检测的患者分别为37.8%和6.1%。在二级医院或诊所接受治疗的患者以及居住在农村地区的患者接受HbA1c检测的可能性较小。即使在调整了个体和地区层面的特征后，仍观察到显著的地区层面差异（每年检测频率≥1次、≥2次和≥4次的方差参与者系数分别为7.91%、9.58%和14.43%）。
韩国HbA1c监测频率未达最佳，尤其是在农村地区。此外，观察到显著的地区差异，这意味着存在背景效应。这表明需要制定政策措施来改善HbA1c监测。特别是，必须改善农村基层医疗诊所的HbA1c检测可及性。
