The impact of diabetic HbA1c exam on the occurrence of chronic kidney disease in type 2 diabetic patients

摘要

Background: Diabetes mellitus is a major public health problem in Taiwan. In association with increasing diabetes prevalence, this will result in increasing the associated consequences of many complications of diabetes. And its complication significantly contributes to the morbidity and mortality. Adherence to proposing HbA1c test guideline can be effective in slowing disease progression and risk reduction of complication, but little is known about the relationship between timely intervention of the test that meet the guideline and chronic kidney disease (CKD). Aims :The purpose of this study is to assess the association between adherence to proposing HbA1c test guideline and CKD in type 2 diabetic patients. Methods:The incidence cases were the patients with type 2 diabetes mellitus identified from National Health Insurance Research Database (NHIRD) during 1999-2003. Cox regression was employed to evaluate the association between adherence to proposing HbA1c test guideline and CKD. Results:A total of 16628 patients were identified as newly diagnosed diabetes and 3987 (24.0%) of them developed CKD during the following period. The average duration of the following period was 6.85 years.Among 16628 patients, 8% followed the practice guideline for first two years of the following period and 23 % followed the practice guideline for two years before censor date.Comparing to patients not adherence to proposing HbA1c test guideline for two years before censor date, the hazard risk of CKD of adherence to proposing HbA1c test guideline were 0.306 【95% CI=0.279-0.337】 . Conclusions:Quality of care assessment should include care processes such as HbA1c testing. The study results and study methods may be of use to Type 2 diabetic patients in assessing the quality of care for diabetic patients.