Abstract
Diabetes is a common chronic disease world wide. Its long term complications both microvascular and macrovascular lead to increased medical expenses, hospitalization and death in diabetic patients. It is proven that intensive control of diabetes and its comorbidities prevent or delay its complications, and the standard of care for diabetes has been established and widely accepted. Therefore, it is important to document the current status of diabetic care and complications in Thailand. We conducted a multicenter registry in diabetic clinics of 11 tertiary centers in Bangkok and major provinces. The registry collected data from April-December 2003. There were total of 9419 diabetic patients. The majority of patients were older than 40 year-old (91.7 %) and 65.9% were female. With respect to socioeconomic status, more than half of the patients had only preliminary education or less and not currently working, nevertheless more than 70% had health care coverage. The registry comprised of type1, 4.5%, type2, 94.6% and others 0.9%. The data also showed that 38.9% of the patients had diabetes more than 10 years, and almost 80% were non-smoker. For glycemic control, more than half had inadequate control: 61.8% had fasting plasma glucose > 130 mg/dl and 69.34% had HbA1C > 7%. The analysis of lipids profile revealed that 63.3% had LDL > 100 mg/dl, interestingly only approximately 32.2% had levels of HDL and triglycerides out of the recommended ranges. With regard to complications, the data showed prevalence of retinopathy of various degrees in 23.3%, but 24.4% of the registry did not received evaluation. Almost half of the patients also had not been adequately assessed for nephropathy, for those who had evaluation, 34.9% had some degree of nephropathy. 5.9% of the patients reported a history of foot ulcers, and 1.6% had had amputation. The prevalence of coronary disease, stroke, hypertension and dyslipidemia were 8.2%, 4.4%, 63.6% and 73.3% respectively. Medication usage data showed that 29% of the patients use insulin. The most commonly prescribed regimen was a combination of sufonylurea and metformin (37%) for hypoglycemic agents, and ACE-I and diuretic (6.5%) for antihypertensive. Lipid lowering drugs were prescribed in 54% of the registry which would reflected that 74.5% of dyslipidemia patients received treatment. Non-prescribed herbal preparation was used at one time in at least 33% of the registered patients.Conclusion: The majority of the patients in this registry had unsatisfactory control ofdiabetes and other risk factors for development of long term complications. Screening for early retinopathy and nephropathy also was insufficient. There should be additional process or system to improve care for diabetes.
