Effectiveness of quality of care for patients with type 2 diabetes in China: findings from the Shanghai Integration Model (SIM)
Chun Cai1, Yuexing Liu1, Yanyun Li2, Yan Shi2, Haidong Zou3, Yuqian Bao1, Yun Shen1, Xin Cui4, Chen Fu2(), Weiping Jia1(), the SIM Study Group
1. Shanghai Diabetes Institute, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, National Office for Primary Diabetes Care, Shanghai Technical Center for Diabetes Prevention and Clinical Care, Shanghai Key Laboratory of Diabetes Mellitus, Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai 200233, China 2. Shanghai Municipal Center for Disease Control & Prevention, Shanghai 200336, China 3. Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital, Shanghai Key Laboratory of Ocular Fundus Diseases; Shanghai General Hospital, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai 200040, China 4. Shanghai Municipal Health Commission Information Center, Shanghai 200040, China
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 HbA1c (<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 HbA1c 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.
. [J]. Frontiers of Medicine, 2022, 16(1): 126-138.
Chun Cai, Yuexing Liu, Yanyun Li, Yan Shi, Haidong Zou, Yuqian Bao, Yun Shen, Xin Cui, Chen Fu, Weiping Jia, the SIM Study Group. Effectiveness of quality of care for patients with type 2 diabetes in China: findings from the Shanghai Integration Model (SIM). Front. Med., 2022, 16(1): 126-138.
Part A: a All three targets met was defined as HbA1c<7.0%, BP<130/80 mmHg, and LDL-c<2.6 mmol/L.
Part B (continuous outcomes)
HbA1c
SBP
DBP
LDL-c
β (95% CI)
β (95% CI)
β (95% CI)
β (95% CI)
Age
−0.014 (−0.015, −0.013)
0.312 (0.298, 0.327)
−0.209 (−0.217, −0.201)
−0.004 (−0.004, −0.003)
Male (vs. female)
0.141 (0.127, 0.155)
−1.799 (−2.022, −1.576)
1.927 (1.807, 2.047)
−0.284 (−0.295, −0.274)
Diabetes duration
0.043 (0.041, 0.044)
0.055 (0.035, 0.075)
−0.111 (−0.122, −0.100)
−0.001 (−0.002, 0.000)
Current smoker (vs. none)
0.108 (0.076, 0.139)
−2.804 (−3.294, −2.315)
−1.234 (−1.498, −0.970)
0.007 (−0.016, 0.031)
Current drinker (vs. none)
−0.162 (−0.198, −0.127)
1.785 (1.238, 2.333)
0.654 (0.359, 0.949)
0.003 (−0.023, 0.029)
BMI
0.024 (0.022, 0.026)
0.889 (0.853, 0.924)
0.492 (0.473, 0.512)
0.006 (0.004, 0.008)
One or more microvascular diseases (vs. none)
0.373 (0.359, 0.387)
5.553 (5.334, 5.773)
1.553 (1.435, 1.671)
−0.017 (−0.028, −0.007)
One or more macrovascular diseases (vs. none)
−0.150 (−0.164, −0.136)
−1.482 (−1.707, −1.257)
−0.547 (−0.668, −0.426)
−0.066 (−0.077, −0.055)
Glucose-lowering medication (vs. none)
0.530 (0.513, 0.548)
NA
NA
NA
Antihypertensive medication (vs. none)
NA
3.702 (3.457, 3.947)
1.517 (1.386, 1.649)
NA
Lipid-lowering medication (vs. none)
NA
NA
NA
−0.243 (−0.255, −0.231)
Part B: Model for HbA1c: R= 0.344, R2 = 0.118, R2adj = 0.118, P <0.001; Model for SBP: R= 0.295, R2 = 0.087, R2adj = 0.087, P <0.001; Model for DBP: R= 0.272, R2 = 0.074, R2adj = 0.074, P <0.001; Model for LDL-c: R= 0.211, R2 = 0.044, R2adj = 0.044, P <0.001.
Tab.3
Glucose-lowering medication
Antihypertensive medication
Lipid-lowering medication
All three medication treatmentsa
No
Yes
No
Yes
No
Yes
No
Yes
Age (year)
66.00±8.07
66.54±8.13*
63.93±8.13
67.50±7.88*
65.80±8.18
67.95±7.77*
65.86±8.15
68.35±7.70*
Diabetes duration (year)
5.81±4.65
8.49±5.60*
7.43±5.27
8.18±5.62*
7.73±5.37
8.51±5.86*
7.65±5.38
8.99±5.89*
HbA1c (%)
6.67±1.09
7.35±1.24*
7.26±1.28
7.20±1.23*
7.23±1.26
7.19±1.21*
7.20±1.25
7.27±1.21*
<7% (%)
69.1
43.4*
47.6
49.0*
48.4
49.0#
49.4
45.8*
SBP (mmHg)
141.89±18.74
142.26±18.96#
138.02±18.50
143.97±18.81*
142.21±18.93
142.12±18.87
141.93±18.91
143.06±18.92*
DBP (mmHg)
80.87±10.04
80.05±10.09*
79.51±9.92
80.51±10.14*
80.53±10.06
79.43±10.10*
80.41±10.07
79.52±10.11*
BP (%)
<130/80 mmHg
17.1
17.6
23.8
14.8*
17.5
17.5
17.8
16.3*
<130/80 mmHg (<65 years)
20.3
20.4
26.9
16.3*
20.4
20.2
20.8
18.3*
<140/90 mmHg (≥65 years)
40.9
41.0
47.9
38.8*
40.2
42.5*
40.9
41.1
LDL-c mmol/L
3.08±0.84
2.95±0.89*
3.06±0.84
2.94±0.90*
3.04±0.84
2.80±0.96*
3.04±0.85
2.76±0.95*
<2.6 mmol/L (%)
28.6
35.3*
29.3
35.9*
29.8
44.1*
30.5
45.7*
<1.8 mmol/L (%)b
7.8
11.8*
7.7
12.0*
7.7
16.8*
8.3
17.5*
All three targetsc met (%)
4.2
3.6*
4.3
3.5*
3.3
5.0*
3.5
4.7*
All three age-stratified targetsd met (%)
7.7
6.5*
6.4
6.9*
5.8
9.3*
6.2
8.9*
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