Evaluation of blood glucose control and risk factos in type 2 diabetic out patients at hospital of Endocrinology

EVALUATION OF BLOOD GLUCOSE CONTROL AND RISK FACTORS IN TYPE 2 DIABETIC OUT PATIENTS AT HOSPITAL OF ENDOCRINOLOGY

Pham Van Bang, Nguyen Khoa Dieu Van

Hanoi Medical University

DOI: 10.47122/vjde.2022.53.3

ABSTRACT

The study was conducted on 304 outpatients diagnosed with type 2 diabetes at Endocrine Hospital of Thanh Hoa Province from April 2021 to October 2021. Of these 304 patients, 152 patients (50%) were male and 152 patients (50%) were female . Patients in our study were aged from 30 to 90 years old, of which the age group from 50-70 accounted for a high percentage (58.9%), their education level varied from illiteacy to undergraduate and postgraduate. The rate of overweight and obesity in the both male and female patients was high. In which, the proportions of overweight in both sexes, class 1 obesity and class 2 obesity were 30.2%, 18.1%, and 1%, respectively. The satisfactory result rates of blood glucose control according to the guideline of the Vietnam Association of Diabetes and Endocrinology in 2018 were 39.1% and 50% for fasting blood glucose and HbA1C criteria, respectively. The rates of blood lipid control according to the NCEP ATP III standard for triglycerides, LDL and HDL were 42.4%, 35.9% and 36.2%, respectively. Patients with hypertension accounted for 61.8% (188 patients), 59% of which reached the goal of blood pressure treatment according to the criteria of the Vietnam Heart Association (2015).

Keywords: Diabetes, glucose, HbA1C, treatment.

Main correspondence: Pham Van Bang

Submission date: 19th Oct 2022

Revised date: 19th Nov 2022

Acceptance date: 19th Dec 2022

1. BACKGROUND

Diabetes mellitus is a metabolic disorder developed by chronic hyperglycemia, diabetes has a global nature, is a burden on economic and social development for many countries, especially are countries.

Patients with diabetes have a high risk of many serious complications in many organs, which not only reduces the quality of life, increases the patient’s burden of treatment costs, but is also the main cause. lead to disability and death [1]

Hyperglycemia is the main cause of diabetes complications,   besides metabolic cardiovascular risk factors also play a very important role in causing diabetes complications.

Therefore, the monitoring of treatment and glycemic control along with cardiovascular risk factors play an important role to prevent the development and progression of chronic complications [2].

Thanh Hoa Endocrine Hospital is a class II hospital, located in the North Central region. After  14 years of establishment and development, the hospital has implemented many specialized tests and treatment of Endocrinediseases.

Currently, the hospital manages more than 4000 outpatient type 2 diabetes patients in Thanh Hoa province. However, the current situation of blood glucose control of type 2 diabetes patients in the province is still difficult and limited due to the impact of many factors: medical personnel, insurance, socio-economic conditions.

Therefore, the treatment effectiveness is not high. Therefore, in order to better understand the status of blood glucose control in patients with type 2 diabetes in the province, thus offering early intervention measures for better treatment, we performed with objective: To assess the status of blood glucose control and some risk factors in patients with type 2 diabetes are treated as outpatients at Thanh Hoa Endocrine Hospital.

2. METHODS

2.1. Research subjects

304 type 2 diabetes outpatients undergoing treatment at Thanh Hoa Endocrine Hospital’s examination department were selected for the study.

2.2. Time and place of study

The study was conducted at the Outpatient Department – Tsinghua Endocrine Hospital fromApril 2021 to October 2021.

2.3. Research Methods

Cross-sectional, prospective descriptive study. Select samples by convenience method. The data were entered and processed on the computer using SPSS 23.0 software. Use the t-test to compare the mean, the χ2 test to compare the percentages.

The difference was significant when p < 0.05. The difference was not significant when p > 0.05.

3. RESULTS

3.1. General features 3.1.1. Distribution by age

Figure 3.1. Distribution of patients according to age group

Comment: Among 304 patients: The average age of the study was 62.1 ± 11.2, the youngest age of the study was 25, the oldest age of the study was 90. The age group 60-69 accounted for the highest percentage: 33.2% ( n=101), followed by the age group ≥ 70: 27.6% (n=84) and the age group 50-59: 25.7% (n=78). The two age groups that accounted for the lowest proportion were 40-49: 9.9% (n=30) and the age group under 40: 3.6% (n=11).

Comment: The proportion of male and female patients in the study group was completely equal.

Figure 3.2. Characteristics of the study patients

Comment: The proportion of male and female patients in the study group was completely equal.

3.1.2. Distribution by level of education

Figure 3.3. Educational characteristics of study patients

Comments: In the study group, patients with secondary or high school education reached the highest with 57.9% (n = 176). There were 20.4% (n=62) patients with education except Intermediate or higher, and 21.7% (n=66) patients with primary education-illiteracy.

3.1.3. Duration of illness

Table 3.1. The duration of diabetes of the study subjects

Comment: The rate of patients with diabetes from 5 years to less than 10 years accounted for the highest rate of 38.2%. Next, the group of patients with the disease over 10 years and from 1-5 years accounted for 31.6% and 27.6%, respectively. The rate of new patients less than 1 year accounted for the lowest rate of 2.6%.

3.1.4. Clinical characteristics of the study group of patients • BMI:

Table 3.2. Characteristics of BMI distribution of studied patients

Comment: Normal BMI accounted for the highest percentage in both sexes (51.3% in men and 47.4% in women, the overall rate accounted for 49.3%). The prevalence of overweight and obesity is high. In which, the prevalence of overweight in both sexes is 30.2% (male 29.6%; female 30.9%), grade 1 obesity is 18.1% (male 17.1%; female 19.2%), obesity grade 2 was 1% (male 0.7%; female 1.3%).

3.2. Results of blood glucose control and risk factors 3.2.1. Glucose and HbA1C control

• Average blood glucose and HbA1C of study patients

Table 3.3. Average blood glucose and HbA1C

Comment: The average fasting blood sugar of the study subjects was 8.2±2.7 mmol/l (male: 8.2±2.6; female: 8.2±2.9). The lowest is 2.8 mmol/l, the highest is 20.3 mmol/l. The mean HbA1C of the study subjects was 7.3 ± 1.4 (male: 7.2 ± 1.3; female: 7.5 ± 1.6).

• Rates of glycemic control and HbA1C reaching treatment goals

Figure 3.4. Rates of glycemic control and HbA1C reaching treatment goals

Comment: The rate of achieving the goal of fasting blood glucose control was 39.1% (119/304), 60.9% (185/304) of patients with blood glucose control did not reach the target. The proportion of patients reaching the HbA1C goal was 50% (152/304).

3.2.2. Results of blood pressure and blood lipid control – Blood pressure control results

Table 3.4. Results of blood pressure control

Comment: The number of patients with good BP control in the hypertensive group was 59% (n=111), 44% of patients with poor blood pressure control.

Table 3.5. Results of blood lipids reached the target

Comment: Among the study patients, the number of patients reaching the goal of triglycerides was 42.4%, LDL-C was 35.9% and HDL-C was 36.2%

4. DISCUSSION 4.1. General features

In the study of 304 patients with type 2 diabetes undergoing outpatient treatment at Thanh Hoa Endocrinology Hospital, there were 152 female patients (50%) and 152 male patients (50%), so women are equal. This result is quite similar to the study of Bach Mai Hospital (2013), the rate of female is 52.3%, male is 47.7% (3).

There is a difference with the research of author Nguyen Thi Hong Loan (2019) the female rate is 225, accounting for 57.7%, and the male is 165, accounting for 42.3%, in the study Do Trung Quan (2017) at Bach Mai hospital, the percentage of men is male. and women are 46% and 54% (4) (5), respectively.

About the age of the study patients: The average age was 62.1 ± 11.2, the youngest age of the study was 25, the oldest age of the study was 90.

The age group from 50-70 accounted for the highest percentage, accounting for 58.9% and at least under 40 years old. The results show that the disease is concentrated in middle-aged and elderly patients. The results are consistent with the studies Do Trung Quan (2017) and Nguyen Thi Hong Loan (2019) with a high proportion of patients from 50 years old. This shows that the majority of patients with diabetes are middle-aged and elderly patients.

Most of the study group’s education level completed lower secondary and high school (57.9%), the number of education from Intermediate-Postgraduate accounted for 20.4% and 21.7% of the patients had a high level of education. low level of illiteracy-Primary. Research results at Bach Mai Hospital, from intermediate level 22.7% [3].

Meanwhile, studies by Nguyen Thi Hong Loan at Tue Tinh Hospital and Nguyen Thi Thu Hang at Hanoi Post Hospital show that with intermediate or higher qualifications, 36.16% and 71.2%, respectively.  [6]. This is understandable because the difference in education level by region is different. In which, Thanh Hoa province also has many mountainous districts and ethnic minorities. Therefore, the overall proportion of patients with a high level of education is still low. This may affect patient compliance and treatment outcomes.

The mean duration of disease in our study was 5.81 years. In which, the rate of patients suffering from the disease from 5 to 10 years accounts for the highest rate is 39.1%, from 1 to 5 years is 27%, over 1 year is 31.9%, patients with disease less than 1 year account for the proportion.

The lowest rate is 2%. From the study, the number of patients with diabetes from 5 years or more accounts for a high percentage. The results are different from the study of Nguyen Thi Hong Loan: the highest rate of patients with diabetes in 1-5 years is 39.8%, from 6 to 10 years is 25.6%, over 10 years is 23.3%, below 1 year accounts for the lowest rate of 11.3%.

4.2. Clinical features

Overweight and obesity is one of the risk factors for type 2 diabetes. In our study, the average BMI of the study subjects was 23.17 ± 2.5, the female BMI was 23.29 ± 2.5 greater than male BMI is 23.04±2.4, the difference is not statistically significant with p > 0.05 The overall rate of overweight and obese patients in our study is 150 (49.3%), similar to the study. Research by Cao Thi Minh Thuy (2020) (50.5), lower than that of Tran Thi Lich (69.4%) [7] [8]. There are differences in the results of these studies that can be explained by the differences in the research subjects and the characteristics of eating and living habits according to the study region.

4.3. Results of blood glucose control and risk factors

Hyperglycaemia is the leading cause of chronic complications of diabetes, especially cardiovascular complications. Strict control of blood glucose helps limit diabetes complications, prolonging the life of patients.

In our study, 39.1% of patients achieved the goal of fasting blood glucose, the average blood glucose was 8.25±2.79, the smallest blood glucose value was 2.8, the maximum was 20.3. The average HbA1c of the study subjects was 7.39 ± 1.47, the highest value was 13.3%, the lowest value was 4.6%, the percentage of patients achieving the target HbA1c was 50%. Research results of Nguyen Thi Hong Loan: 50.3% of the study patients reached the target HbA1c and the average HbA1c of the study subjects was 7.13±1.12. Nguyen Thi Thu Hang: HbA1C control rate is 59.2%; achieved the target of fasting blood glucose control of 58.5%.

The rate of glucose control and HbA1C in our study may be due to differences in resources, drug regimens that are highly dependent on health insurance, and limited economic conditions.

Therefore, the rate of blood glucose control reaching the target is still low. Hypertension and dyslipidemia increase cardiovascular events in patients with diabetes. Thus, to improve the quality of diabetes management, it is necessary to well manage blood pressure and blood lipids.

Our study showed that the proportion of diabetic patients with hypertension was much higher than that of Nguyen Thi Hong Loan’s study (35.1%), lower than that of Cao Thi Minh Thuy’s study (66, 34%).

The rate of blood pressure control reaching the target is still low compared to Cao Thi Minh Thuy (65.67%). The rate of blood lipid control reaching the target was different with Nguyen Thu Hang (Triglycerid: 41.5%; LDL-C: 52.6%, HDL-C: 35.0%) and Nguyen Thi Hong Loan (Triglycerid: 28.5%; LDL-C: 38.61%, HDL-C: 44.33%.

The difference may be due to differences in patients, living habits, exercise, and drugs to treat dyslipidemia    of    different    localities. Therefore, it is necessary to pay attention and guide to raise patients’ awareness about nutrition, exercise and drug treatment to limit the risk of  developing atherosclerotic cardiovascular events.

5. CONCLUSION

Among 304 type 2 diabetes patients being treated as outpatients at Thanh Hoa Endocrinology Hospital, the prevalence by sex is equal (50% of each sex). The age of the disease is mainly from the group of over 50 years old (86.5%), the mean duration of the disease is 5.81 years. The rate of overweight and obesity was 49.3%.

Regarding glycemic control and risk factors: The percentage of patients who reached the fasting glucose target was 39.1%. HbA1C is 50%.

The rate of hypertension in patients with diabetes is 61.8%, of which 59% blood pressure control reaches the treatment goal. Blood lipid control reached the goal of triglycerides of 42.4%, LDL-C and HDL-C of 35.9% and 36.2%, respectively.

REFERENCES

1. American Diabetes Association (2019), “2. Classification and diagnosis of diabetes: standards of medical care in diabetes 2019”, Diabetes care, 42. S13-S28.

2. Pouya Saeedi, et al. (2019), “Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes    Atlas”,    Diabetes research and clinical practice, 157. 107843.
3. Tran Thanh Hoa (2013). Evaluation of treatment results for patients with type 2 diabetes treated as outpatients at the outpatient clinic at the request of Bach Mai Hospital, Master of Medicine Thesis, Hanoi Medical University.
4. Nguyen Thi Hong Loan (2019). Evaluation of the status of blood glucose control and some risk factors in patients with type 2 diabetes treated as outpatients at Tue Tinh hospital.    Thesis    II,    Hanoi    Medical University

5. Do Trung Quan (2017). Evaluation of the effectiveness of outpatient type 2 diabetes management at Bach Mai Hospital under the Jade program. Bach Mai Hospital.
6. Nguyen Thi Thu Hang (2015). Review of the current status of blood glucose and lipid control in patients with type 2 diabetes treated as outpatients at Post Office Hospital, Specialized Thesis II, Hanoi Medical University.
7. Tran Thi Lich (2019). Current status of multifactorial control in patients with type 2 diabetes treated as outpatients at Dien Bien Provincial General Hospital. Thesis of Master of Medicine. Hanoi Medical University