Typical management practice in outpatients with type 2 diabetes mellitus in cities, towns, and villages

Aim. To analyze one-year typical management practice in outpatients with type 2 diabetes mellitus (T2DM) in cities, towns, and villages. Subjects and methods. 438 records of T2DM outpatients regularly visiting their physicians during 2009 were retrospectively analyzed. Group 1 included 221 outpatients from 7 polyclinics of the Kirov Regional Center; Group 2 consisted of 227 patients from 36 districts of the Kirov Region. VEN-, ABC-, and frequency analyses were made; the costs of drug therapy and hospitalization for the included patients were calculated. Results. The investigation revealed the low efficiency of sugar-lowering therapy (SLT), insufficient glycated hemoglobin testing rates (15% in Group 2 during a year), inadequate correction of SLT. During one year the number of patients with fixed target office blood pressure levels in Group 1 increased from 16.6 to 34.1% (р<0.001) and that in Group 2 was statistically significantly unchanged (21.6% vs 25.1%; p=0.05). In Group 2, the use frequency of statins was lower (20.3% by the end of the year versus 49.3% in Group 1; р<0.001); the examination quality was worse; the drugs with unproven efficacy, the cost of which was higher than that of statins/disaggregants, were used more often. In Groups 1 and 2, there were 50 (23.7%) and 95 (41.9%) patients who were more commonly hospitalized for T2DM-related causes; Group 2 patients had a higher rate of hospitalizations and longer inpatient treatment. Conclusion. The worse outpatient care quality in the towns and villages was followed by increases in a need for inpatient treatment and in direct drug (2.36-fold) and non-drug direct and indirect (2.77-fold) costs.

therapy for type 2 diabetes mellitus, patient management in typical practice, evaluation of treatment efficiency, clinical and economic analysis, VEN-analysis, ABC-analysis, frequency analysis