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Exploration the Standard diagnosis and treatment in Patients with Type 2 Diabetes in a tertiary first-class hospital in Fujian Province

By Xiaoyan Lin, Wei Lin, Junping Wen, Gang Chen

Posted 10 Mar 2020
medRxiv DOI: 10.1101/2020.03.06.20026591

ObjectiveThe aim of this study was to evaluate the knowledge and clinical practice of guideline for prevention and treatment of Type 2 diabetes in China among the physicians. We took a tertiary first-class hospital in Fujian Province as an example to identify the differences between clinical practice and guideline. MethodsWe selected 3000 inpatients with type 2 diabetes who visited at the tertiary first-class hospital in Fujian Province between September 2017 to November 2017, then retrospectively analyzed their clinical data, including age, gender, height, weight, body mess index, admission departments, combined diseases, complications, course of disease, diabetes diet education, monitoring of blood glucose and blood pressure, the selection of hypoglycemic therapy and other secondary prevention measures. The data we obtained was analyzed by SPSS 19.0 software. ResultsA total of 3000 effective inpatient were enrolled, including 1724 male and 1276 female, the mean age({+/-} standard deviation) of patients was 66.21 {+/-} 11.75 years, the mean hospitalization days was 12.26{+/-}10.30 days.In this study, we found that:1.only 60.9% of the patients have monitored HbA1C in nearly 3 months; in the last year, 96.3% of patients have monitored blood lipid;98.1% of patients have monitored the serum creatinine;only 9.5% of patients have received comprehensive eye examination by an ophthalmologist or optometrist.2.After admission, 73.3% of patients have received the education about diabetes diet; 86.8% of patients have accepted the peripheral blood glucose monitoring;among 2084 diabetic patients combined with hypertension, only 1868 patients (89.6%) have received blood pressure monitoring.3. Among 202 patients who are newly diagnosed diabetes, there were 45 cases meet HbA1C > 9.0% or FPG > 11.1 mmol/ L, only 25 people (55.56%) have received an intensive insulin therapy.4.Among 474 patients who have undergone an large or medium-sized surgical treatment, about 182(62.1%) patients have started a hypoglycemic therapy before the operation, and only 196(41.4%) patients have changed into intensive insulin therapy before surgery.5. About 714 of diabetic patients who combined with a clear history of cardiovascular, only 548 (76.8%) patients have received antiplatelet therapy;and 566 people (79.3%) have used statin to lower blood lipid. 6.In total, only 168(5.6%) patients have received a relatively standard diagnosis and treatment in non-surgical department, and only 4(0.1%) patients in surgical department. ConclusionThere are still many deficiencies in clinical practice of type 2 diabetes guideline, even in tertiary first-class hospital, there are also many physicians, especially non-specialist doctors, were not familiar with the knowledge of guideline for management of Type 2 diabetes.The acute exacerbation of diabetes in the global can take serious complications and bring heavy economic burden, so it required us to pay attention to the prevention and early treatment of diabetes. We suggest to popularize the "guideline for management of Type 2 diabetes" through various forms, such as academic seminars, lecture tour and medical staffs, so as to enhance the education of physicians and promote treatment based on guideline of type 2 diabetes.

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