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. 2016 Jul 26;8(1):59-68.
doi: 10.1007/s13340-016-0280-0. eCollection 2017 Mar.

Trends in medical performance in diabetic patients in primary care clinics compared with those in hospitals: Shiga Diabetes Clinical Survey, Japan, 2000-2012

Itsuko Miyazawa  1 , Aya Kadota  2   3 , Motozumi Okamoto  4 , Katsuyuki Miura  2   3 , Hiroshi Maegawa  1 , Atsuo Ohnishi  5   6 ; Shiga Diabetes Clinical Survey Group
Collaborators, Affiliations

Trends in medical performance in diabetic patients in primary care clinics compared with those in hospitals: Shiga Diabetes Clinical Survey, Japan, 2000-2012

Itsuko Miyazawa et al. Diabetol Int. .

Abstract

Aims: This study aimed to clarify trends in clinical performance in diabetic patients over a 12-year period in primary care clinics and hospitals in Japan.

Materials and methods: The Shiga Diabetes Clinical Survey records medical performance in diabetic patients in primary care clinics and hospitals in Shiga Prefecture, Japan. In this study, laboratory data, modality of treatment for diabetes, and status of examination for diabetic complications were examined using results of surveys in 2000, 2006, and 2012. The study included 17,870, 18,398, and 24,219 patients for those years, respectively.

Results: Mean glycated hemoglobin (HbA1c) level significantly improved over 12 years and was significantly lower in the primary care clinics group than the hospitals group (7.3 ± 1.5 vs. 7.4 ± 1.4 % in 2000, 7.2 ± 1.2 vs. 7.4 ± 1.3 % in 2006, and 6.9 ± 1.0 vs. 7.1 ± 1.1 % in 2012). With regard to diabetic treatment modality, patients treated in hospitals used insulin more frequently than those in primary care clinics. The proportion of patients examined for diabetic complications increased but did not reach 50 % in 2012. Mean blood pressure and low-density lipoprotein cholesterol levels were lowered, but blood pressure control was worse than that of low-density lipoprotein cholesterol.

Conclusions: This study shows that glycemic control in both primary care clinics and hospitals has improved and was almost acceptable. However, examinations for diabetic complications and the control of blood pressure were still insufficient.

Keywords: Clinical survey; Diabetes mellitus; Japanese; Medical performance.

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Conflict of interest statement

The authors declare no conflicts of interest.This study was conducted in accordance with the Declaration of Helsinki, “Personal Information Protection Law” of Japan, “Ethical Guidelines in Epidemiological Research” compiled the Ministry of Education, Culture, Sports, Science and Technology and the Ministry of Health, Labor and Welfare of Japan.The study was approved by a committee including experts in ethical matters and the board of the Shiga Medical Association and by the ethical standards of the responsible committee on human experimentation (Shiga University of Medical Science).

Figures

Fig. 1
Fig. 1
Proportion of patients according to categories by glycated hemoglobin (HbA1c) levels in primary care clinics (PCCs) and hospitals in 2000, 2006, and 2012
Fig. 2
Fig. 2
Proportion of each therapeutic modality among patients in primary care clinics (PCCs) and hospitals in 2000, 2006, and 2012. OHA orally administered hypoglycemic agents, GLP-1 glucagon-like peptide-1
Fig. 3
Fig. 3
Trends of mean glycated hemoglobin (HbA1c) levels by diabetic treatment among patients in primary care clinics (PCCs) and hospitals from 2000 to 2012. OHA orally administered hypoglycemic agents. *P for trend <0.001
Fig. 4
Fig. 4
a Trends of proportion of patients examined for urinary albumin within 1 year in primary care clinics (PCCs) and hospitals from 2000 to 2012. b Proportion of patients examined for urinary albumin within 1 year by glycated hemoglobin (HbA1c) levels in PCCs and hospitals in 2000, 2006, and 2012. *P for trend <0.001
Fig. 5
Fig. 5
Trends of proportion of patients a given retinal screening within 1 year in primary care clinics (PCCs) and hospitals from 2000 to 2012 and b of patients with retinal screening within 1 year by glycated hemoglobin (HbA1c) levels in PCCs and hospitals in 2000, 2006, and 2012. *P for trend <0.001
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