Helen C McGuire1, Linong Ji2, Katarzyna Kissimova-Skarbek3, David Whiting4, Florencia Aguirre4, Puhong Zhang5, Shaoda Lin6, Chunxiu Gong7, Weigang Zhao8, Juming Lu9, Xiaohui Guo10, Ying Ji11, Till Seuring4, Tianpei Hong12, Lishu Chen13, Jianping Weng14, Zhiguang Zhou15. 1. International Diabetes Federation, Chausée de la Hulpe 166, Watermael Boitsfort, 1170 Brussels, Belgium; PATH, 455 Massachusetts Ave NW, Washington DC, 20001, USA. Electronic address: hmcguire@path.org. 2. Department of Endocrinology and Metabolism, Peking University People's Hospital, No. 11, Xizhimen Nan Da Jie, Xicheng District, Beijing 100044, PR China. Electronic address: jilinong@gmail.com. 3. International Diabetes Federation, Chausée de la Hulpe 166, Watermael Boitsfort, 1170 Brussels, Belgium; Jagiellonian University Medical College, Faculty of Health Sciences, Department of Health Economics and Social Security, Poland. 4. International Diabetes Federation, Chausée de la Hulpe 166, Watermael Boitsfort, 1170 Brussels, Belgium. 5. The George Institute for Global Health at Peking University Health Science Center, Level 18, Tower B, Horizon Tower, 6, Zhichun Road, Haidian District, Beijing 100088, China. 6. Department of Endocrinology and Metabolism, The First Affiliated Hospital of Shantou University Medical College, No. 57, Changping Road, Shantou 515041, Guangdong Province, China. 7. Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, No. 56 South Lishi Road, Xicheng District, Beijing, 100045, China. 8. Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, 100730, Beijing, China. 9. Department of Endocrinology, PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing 100853, China. 10. Department of Endocrinology, Peking University First Hospital, 7 Xishiku St, Xicheng District, Beijing 100034, China. 11. Department of Social Medicine and Health Education, School of Public Health, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing 100191, China. 12. Department of Endocrinology and Metabolism, Peking University Third Hospital, No.49, Huayuan North Road, Haidian District, Beijing 100191, China. 13. Department of Endocrinology, The Second Affiliated Hospital of Shantou University Medical College, No. 69, Dongxia North Road, Shantou 515000, Guangdong Province, China. 14. Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou 510630, Guangdong Province, China. 15. Institute of Metabolism and Endocrinology, The Second Xiangya Hospital, Key Laboratory of Diabetes Immunology, Ministry of Education, Central South University, National Clinical Research Center for Metabolic Diseases, No. 139, Renmin Middle Road, Furong District, Changsha 410011, Hunan Province, China.
Abstract
AIMS: The paucity of data on Type 1 diabetes in China hinders progress in care and policy-making. This study compares Type 1 diabetes care and clinical outcomes in Beijing and Shantou with current clinical guidelines. METHODS: The 3C Study was a cross-sectional study of the clinical practices and outcomes of people with Type 1 diabetes. The study sequentially enrolled 849 participants from hospital records, inpatient wards, and outpatient clinics. Data were collected via face-to-face interviews with patients and health professionals, the Summary of Diabetes Self-Care Activities, medical records, and venous blood samples. Care was audited using ISPAD/IDF indicators. Data underwent descriptive analysis and tests for association. RESULTS: The median age was 22years (IQR=13-34years), and 48.4% of the sample had diabetes less than six years. The median HbA1c was 8.5% (69mmol/mol) (IQR 7.2-10.5%), with significant regional variance (p=0.002). Insulin treatment was predominantly two injections/day (45% of patients). The highest incidence of diabetic ketoacidosis was 14.4 events/100 patient years among adolescents. Of the 57.3% of patients with LDL-C>2.6mmol/L, only 11.2% received treatment. Of the 10.6% considered hypertensive, 47.1% received treatment. Rates of documented screening for retinopathy, nephropathy, and peripheral neuropathy were 35.2%, 42.3%, and 25.0%, respectively. The median number of days of self-monitoring/week was 3.0 (IQR=1.0-7.0). There were significant differences in care practices across regions. CONCLUSIONS: The study documented an overall deficit in care with significant regional differences noted compared to practice guidelines. Modifications to treatment modalities and the structure of care may improve outcomes.
AIMS: The paucity of data on Type 1 diabetes in China hinders progress in care and policy-making. This study compares Type 1 diabetes care and clinical outcomes in Beijing and Shantou with current clinical guidelines. METHODS: The 3C Study was a cross-sectional study of the clinical practices and outcomes of people with Type 1 diabetes. The study sequentially enrolled 849 participants from hospital records, inpatient wards, and outpatient clinics. Data were collected via face-to-face interviews with patients and health professionals, the Summary of Diabetes Self-Care Activities, medical records, and venous blood samples. Care was audited using ISPAD/IDF indicators. Data underwent descriptive analysis and tests for association. RESULTS: The median age was 22years (IQR=13-34years), and 48.4% of the sample had diabetes less than six years. The median HbA1c was 8.5% (69mmol/mol) (IQR 7.2-10.5%), with significant regional variance (p=0.002). Insulin treatment was predominantly two injections/day (45% of patients). The highest incidence of diabetic ketoacidosis was 14.4 events/100 patient years among adolescents. Of the 57.3% of patients with LDL-C>2.6mmol/L, only 11.2% received treatment. Of the 10.6% considered hypertensive, 47.1% received treatment. Rates of documented screening for retinopathy, nephropathy, and peripheral neuropathy were 35.2%, 42.3%, and 25.0%, respectively. The median number of days of self-monitoring/week was 3.0 (IQR=1.0-7.0). There were significant differences in care practices across regions. CONCLUSIONS: The study documented an overall deficit in care with significant regional differences noted compared to practice guidelines. Modifications to treatment modalities and the structure of care may improve outcomes.