Medical and Dental Consultantsí Association of Nigeria
Home - About us - Editorial board - Search - Ahead of print - Current issue - Archives - Submit article - Instructions - Subscribe - Advertise - Contacts - Login 
  Users Online: 929   Home Print this page Email this page Small font sizeDefault font sizeIncrease font size
 

  Table of Contents 
ORIGINAL ARTICLE
Year : 2016  |  Volume : 19  |  Issue : 6  |  Page : 784-792

Simultaneous control of blood glucose, blood pressure, and lipid among drug-treated Type 2 diabetes patients from Shaanxi province, North-Western China: A multicenter study


1 Department of Endocrinology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
2 Department of Dermatology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
3 Department of Endocrinology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
4 Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
5 Department of Endocrinology, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
6 Department of Endocrinology, Shaanxi Provincial People's Hospital, Xi'an, China
7 Department of Nutrition, Xi'an Municipal Central Hospital, Xi'an, China

Date of Acceptance21-Jan-2016
Date of Web Publication4-Nov-2016

Correspondence Address:
Prof. Q Ji
Department of Endocrinology, Xijing Hospital, Fourth Military Medical University, 169 Changle West Road, Xi'an 710032
China
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1119-3077.181359

Rights and Permissions
   Abstract 

Aim: To investigate the percentage of patients with Type 2 diabetes mellitus (T2DM) who achieved simultaneous control of glycated hemoglobin (HbA1c), blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) and also to assess its determinants in Shaanxi province, North-Western China.
Materials and Methods: This cross-sectional survey was conducted between March and June 2012 in six tertiary hospitals across Shaanxi province. Subjects with known T2DM who had at least one antidiabetic medicine were invited. A questionnaire was used to collect basic information and blood samples were drawn for laboratory measurements. Simultaneous control was defined as HbA1c <7%, BP <130/80 mmHg, and LDL-C <2.6 mmol/L.
Results: A total of 2274 individuals were included, of which 588 individuals (25.9%) achieved good glycemic control (HbA1c <7%) and only 102 (4.5%) attained simultaneous control. The percentage of individuals (24.2%) achieving simultaneous control increased with less stringent goals (HbA1c <8%, BP <140/90 mmHg, and LDL-C <2.8 mmol/L). In addition, multivariate analyses showed that body mass index of 24–28 kg/m2 (odds ratio [OR]: 0.577, 95% confidence interval [CI]: 0.376–0.886), HbA1c above 8% at diagnosis (pooled OR: 0.392, 95% CI: 0.254–0.531), and insulin treatment (pooled OR: 0.412, 95% CI: 0.225–0.594) were the independent predictors of simultaneous control.
Conclusion: Simultaneous control among drug-treated Type 2 diabetes patients was amazingly low in North-Western China. Our present study confirmed the gap between guideline and practice and provided evidence of the need for aggressive diabetes management.

Keywords: Blood pressure, China, control, glycated hemoglobin, low-density lipoprotein cholesterol, Type 2 diabetes mellitus


How to cite this article:
Xu S, Sun F, Xu W, Jiao K, Shi B, Xie X, Wang Y, Zhu M, Ji Q. Simultaneous control of blood glucose, blood pressure, and lipid among drug-treated Type 2 diabetes patients from Shaanxi province, North-Western China: A multicenter study. Niger J Clin Pract 2016;19:784-92

How to cite this URL:
Xu S, Sun F, Xu W, Jiao K, Shi B, Xie X, Wang Y, Zhu M, Ji Q. Simultaneous control of blood glucose, blood pressure, and lipid among drug-treated Type 2 diabetes patients from Shaanxi province, North-Western China: A multicenter study. Niger J Clin Pract [serial online] 2016 [cited 2020 Jan 22];19:784-92. Available from: http://www.njcponline.com/text.asp?2016/19/6/784/181359


   Introduction Top


Due to the rapid change to Western diet and sedentary lifestyle,[1] China has become one of the top countries with the largest number of people suffering from diabetes in the world.[2],[3],[4] The most recent two nationwide diabetes surveys indicated that the prevalence of Type 2 diabetes mellitus (T2DM) has reached 9.7% and 11.6%, translating into 92.4 million and 113.9 million patients in China, respectively.[5],[6] On the other hand, the control of diabetes remained substantial unsatisfactory. For example, it was estimated that the 35% of individuals with known diabetes had fasting plasma glucose <126 mg/dl in 2000–2001 and only 39.7% of the estimated 113.9 million Chinese adults with diabetes had glycated hemoglobin (HbA1c)<7.0% National Glycohemoglobin Standardization Program units (53 mmol/mol International Federation of Clinical Chemistry units) in 2010.[5],[7]

Diabetes contributes greatly but not solely to the development of cardiovascular diseases and chronic complications.[8],[9] Hypertension and hyperlipidemia are the two most important remaining risk factors.[10],[11] Clinical practice guidelines from professional organizations around the world collectively suggest that patients with diabetes should attain a simultaneous control of their risk factors including hyperglycemia, hypertension, and hyperlipidemia in an aggressive and timely manner.[12],[13],[14],[15] Unfortunately, few are successful in achieving these goals. Previous studies have reported comparatively low prevalence rates of simultaneous control, most of which range from 5% to 30%.[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27] In China, Li et al.[28] conducted a hospital-based survey which included 1151 patients with T2DM in Beijing in 2009, and the results showed that the percentage of patients achieving the targets for HbA1c was 37.8%, blood pressure (BP) 65.6%, and low-density lipoprotein cholesterol (LDL-C) was 34.0%, respectively. However, the rate of simultaneous control was not provided. Simultaneous control of HbA1c, BP, and LDL-C is collectively known as the “ABCs of Diabetes.” Despite the fact that many researches have examined the individual components of the “ABCs of diabetes,” only a few have reported the percentage of simultaneous control,[5], 7, [28],[29],[30],[31],[32],[33],[34],[35] and particularly in China, there lack epidemiologic studies focusing on this point.

As an underdeveloped province in China, Shaanxi features a relatively limited health care system and thus may have a less satisfactory diabetes control. Therefore, we conducted a multicenter cross-sectional survey; we aimed to investigate the percentage of patients with T2DM receiving oral drugs or injections who achieved simultaneous control of HbA1c, BP, and LDL-C and also to assess its determinants in Shaanxi province, North-Western China.


   Materials and Methods Top


Study design

This multicenter, cross-sectional survey, as a part of the China HbA1c Surveillance Plan 2012, was conducted between March and June 2012 in six tertiary hospitals across Shaanxi province (i.e. Xijing Hospital of Fourth Military Medical University, Tangdu Hospital of Fourth Military Medical University, First Affiliated Hospital of Xi'an Jiaotong University, Second Affiliated Hospital of Xi'an Jiaotong University, Shaanxi Provincial People's Hospital, and Xi'an Municipal Central Hospital). A sample size of 900–1900 patients was planned to provide an 80% power to detect a 5–10% simultaneous control rate of diabetes (with 95% confidence intervals [CIs], α = 0.05, and β = 0.2) according to previous reports.[23],[26],[27]

The study was approved by the Ethics Committee of Chinese PLA General Hospital as a sponsor and all the six participating hospitals. All the participants signed written informed consent prior to data collection.

Study population

Each clinic day during the study period, the first seven patients with known T2DM who visited the outpatients Departments of Endocrinology in the six tertiary hospitals and met the eligibility criteria were randomly invited to participate by trained doctors.

Finally, a total of 2274 patients with diabetes receiving oral drugs or injections were included as study population (estimated response rate >80%).

Data collection

A questionnaire was administered by trained doctors to collect the data of basic information, glycemic profile at diabetes diagnosis, treatment regimen, concomitant disease (i.e., hypertension, dyslipidemia coronary, heart disease, and cerebrovascular disease), and diabetes complications (i.e., diabetic retinopathy, diabetic neuropathy, diabetic nephropathy, and diabetic foot). The details can been seen in Appendix 1 [Additional file 1]. Height and weight were measured with the participants without shoes and with light dress according to a standard protocol. Body mass index (BMI) was calculated as weight in kilograms divided by height in meters squared. BP was measured using a standardized mercury sphygmomanometer in the sitting position after at least 5 min of rest; two consecutive readings of BP were taken on the same arm, and the mean of the two measurements were recorded.

All laboratory evaluation was performed in the local hospitals where the interview was conducted. Fasting blood samples were collected to measure HbA1c, fasting plasma glucose, triglyceride, total cholesterol, and LDL-C level. Two-hour postprandial blood samples were also collected after a meal to measure 2 h postprandial plasma glucose level. HbA1c (%) was measured in fresh EDTA blood samples by using high-performance liquid chromatography (Tosoh Automated Glycohemoglobin Analyzer, Tosoh Corporation, Japan). Plasma glucose, triglyceride, total cholesterol, and LDL-C were analyzed enzymatically by using an Auto Biochemical Analyzer (MODULAR-000GS; Roche, Basel, Switzerland). LDL-C was determined by a commercial homogeneous direct measurement method (Reagent: Shanghai Fosun Long March Medical Science Co., Ltd., Shanghai, China). The laboratory variation coefficient of triglyceride, total cholesterol, and LDL-C was 4.2%, 1.7%, and 3.8%, respectively. All blood samples were analyzed within 4 h after being collected.

Definitions

Simultaneous control was defined by using the 2013 guideline from the American Diabetes Association as HbA1c <7%, BP <130/80 mmHg, and LDL-C <2.6 mmol/L (100 mg/dl).[12] To evaluate the effect of individualized control goal on the proportion achieving simultaneous control, several sets of targets were set and the corresponding control rates were calculated [Table 1].[16]
Table 1: Effect of varying goal on the percentage of glycemic control and simultaneous control

Click here to view


Statistical analysis

Statistical analysis was performed in SPSS 18.0 (SPSS Inc., Chicago, IL, USA) and data were expressed as a mean ± standard deviation, median with interquartile range, or percentage as suitable. The comparison between groups was analyzed by t-test or Mann–Whitney U-test for measurement data and Chi-square test for enumeration data.

Logistic regression analyses were conducted to identify the association between all potential predictors and the achievement of glycemic control and simultaneous control. The covariables in each step entered the model by a backward method. P value was two-tailed with a significance level of 0.05.


   Results Top


A total of 2274 patients with diabetes receiving oral drugs or injections were included in the study, of which 1269 (55.8%) were patients with diabetes only, 762 (33.5%) were patients with diabetes plus one risk (hypertension or dyslipidemia), and 243 (10.7%) were patients with two risks (hypertension and dyslipidemia). In total, 588 patients (25.9%) achieved good glycemic control (HbA1c <7%) and only 102 (4.5%) attained simultaneous control of HbA1c <7%, BP <130/80 mmHg, and LDL-C <2.6 mmol/L. The simultaneous control remained unsatisfactory although the rate increased with less stringent goals. Almost 5-fold as many individuals simultaneously achieved less stringent goals (HbA1c <8%, BP <140/90 mmHg, LDL-C <2.8 mmol/L, 24.2%) and half as many individuals simultaneously achieved stringent goals (HbA1c <6.5%, BP <130/80 mmHg, LDL-C <2.6 mmol/L, 2.2%) than standard control goals (HbA1c <7%, BP <130/80 mmHg, LDL-C <2.6 mmol/L, 4.5%)[Table 1].

Compared with individuals with poor glycemic control, the individuals with good glycemic control were older at diagnosis, had higher HbA1c level at diagnosis, longer duration of diabetes, and lower proportion of microvascular complications. The proportion of only oral glucose-lowering drugs treatment in the individuals with good glycemic control was higher than that in individuals with poor glycemic control. Meanwhile, significant differences were observed in all variables except sex, age at diagnosis, self-monitoring of blood glucose, and macrovascular complication between individuals with simultaneous control and those without simultaneous control [Table 2] and [Table 3].
Table 2: Clinical profile and laboratory results of the study population

Click here to view
Table 3: The complications and treatment profile of the study population

Click here to view


Multivariate analyses were conducted to identify the association between glycemic control and simultaneous control with all potential predictors. Male (odds ratio [OR]: 0.777, 95% CI: 0.629–0.960), HbA1c above 8% at diagnosis (pooled OR: 0.287, 95% CI: 0.243–0.330), insulin treatment (pooled OR: 0.454, 95% CI: 0.351–0.553) and having microvascular complications (OR: 0.728, 95% CI: 0.573–0.925) were the independent predictors of glycemic control, while BMI of 24–28 kg/m 2 (OR: 0.577, 95% CI: 0.376–0.886), HbA1c above 8% at diagnosis (pooled OR: 0.392, 95% CI: 0.254–0.531), and insulin treatment (pooled OR: 0.412, 95% CI: 0.225–0.594) were the independent predictors of simultaneous control [Figure 1].
Figure 1: Potential predictive factors for glycemic control and simultaneous control. The covariables in each step enter the model by a forward method. NS=Not significant; Glycemic control=Glycated hemoglobin <7%; Simultaneous control=Glycated hemoglobin <7%; blood pressure <130/80 mmHg; low-density lipoprotein cholesterol <2.6 mmol/L; BMI=Body mass index; DM=Diabetes mellitus; SMBG=Self-monitoring of blood glucose; OGLD=Oral glucose-lowering drug; GLP=Glucagon-like peptide

Click here to view



   Discussion Top


This multicenter survey confirmed the gap between guideline and practice in North-Western China. Around a quarter of patients with T2DM achieved good glycemic control and only 4.5% attained good simultaneous control of HbA1c, BP, and LDL-C. Although we found that less stringent goals enhanced the proportion achieving simultaneous control, individualized strategies among different patients did not provide satisfactory simultaneous control. Moreover, we found that male, HbA1c above 8% at diagnosis, insulin treatment and having microvascular complications were all independently associated with poor glycemic control; we also found that BMI of 24–28 kg/m 2, HbA1c above 8% at diagnosis and insulin treatment were the independent predictors associated with poor simultaneous control. This discrepancy of predictive factors seemed to highlight the important relationship of body weight with simultaneous control rather than with glycemic control.

Simultaneous control of HbA1c, BP, and LDL-C is collectively known as the “ABCs of diabetes.”[17] Diabetes, hypertension, and dyslipidemia all cause vascular damage, and simultaneous control of all these risk factors should be the goal standard in patient care. Emphasis on vascular health has now given rise to a new discipline called vascular medicine. The simultaneous control rate has been previously reported with a range from 5% to 30%. For example, using data from the National Health and Nutrition Examination Survey (NHANES) 1988–1994,[23] NHANES 1999–2000,[23] NHANES 1999–2002,[26] NHANES 2003–2004,[27] Look Action for Health in Diabetes 2001–2004,[21] Community-based Endocrinology Practice 2000–2004,[19] and Iowa City Veterans Affairs 2008–2009,[17] the rate was 5.2%, 7.3%, 7.0%, 13.2%, 10.1%, 22.0%, and 17.3%, respectively. Schroeder et al.[16] performed a retrospective cohort study from 2000 to 2008 and reported that 16–30% individuals achieved simultaneous control. In our present study, the percentage of individuals with simultaneous control was only 4.5%, which was much lower than those in previous studies. Although the rate increased with less stringent goals, the simultaneous control remained unsatisfactory. An important point must be stated that we only included the patients with at least one antidiabetic medication and excluded those on lifestyle modification. It likely reduced the proportion of patients achieving achievement of A1c, blood pressure, and cholesterol targets and the simultaneous control rate may be underestimated. Despite this, we showed that China may face a sharper challenge of simultaneous control in diabetic patients compared with Western countries although it is not suitable to directly compare studies due to the differences in patient samples and study methodology. In addition, our results showed that there may be a regional difference in glycemic control in China. For example, our present study identified a good glycemic control rate of 25.9% in North-Western China, whereas Xu et al.[5] conducted a nationwide survey in 2010 and reported that 39.7% of individuals with previous diagnosed T2DM had good glycemic control.

Potential risk factors associated with simultaneous control were previously discussed.[16],[19],[21],[22] Factors such as age, duration of diabetes, insulin treatment, and diabetic complications were all well-described, of which age in our study showed a weak association and insulin treatment were significantly associated with simultaneous control. Actually, since cross-sectional design cannot decide a causal relationship, insulin treatment as a risk factor, for example, was really likely a reflection of the disease process rather than an indictment of insulin per se. However, because risk factors for glycemic control and simultaneous control were both explored and listed together for comparison, we found two important and interesting phenomena in our present study. One was HbA1c at diagnosis as a factor, which, rather than duration of diabetes, was the strongest significant predictor of both control rates, suggesting that physicians should put emphasis on the patients with a higher HbA1c at diagnosis. Another was BMI as a factor, which differed in the association with glycemic control and simultaneous control. We found that BMI (24–28 kg/m 2) was significantly associated with poor simultaneous control, whereas there was no significant association between BMI and glycemic control. The phenomenon is common in clinical practice that an obese patient with T2DM has the possibility to gain glycemic control but is hard to maintain BP or lipids control. This discrepancy of risk factors seemed to highlight the importance of body weight as a modifiable risk factor associated with simultaneous control rather than with glycemic control.

Several limitations in the study should be addressed. First, the cross-sectional nature decides a possible deficiency of causal inferences, particularly in the relationship between predictive risk factors and diabetes control. Second, as our study was a hospital-based survey, potential selection bias should be considered and the results observed in our study may not be generalized to general population. Third, some data (e.g. HbA1c at diagnosis) which were collected from patient interviews and self-reports may result in recalling bias, although patient interviews are the most practical way of gaining such information in China. Last, we could not obtain a wide variety of socioeconomic and demographic data (e.g., educational level, physical activities, diet, and smoking status) as most of other related studies did,[19],[20],[22],[23] which therefore limits the robustness of the multivariate analyses.


   Conclusion Top


In summary, we found that around a quarter of patients with T2DM receiving oral drugs or injections were able to achieve good glycemic control but only 4.5% attained good simultaneous control of HbA1c, BP, and LDL-C. Although less stringent goals had a relatively large effect on the proportion of patients achieving control, the simultaneous control rate remained amazingly low and unsatisfactory. Our present study confirmed the gap between guideline and practice in North-Western China and also provided evidence of need for aggressive diabetes management including HbA1c, BP, and lipid, which contributed to a reduction of cardiovascular disease.

Acknowledgment

We thank all the investigators and patients of the study, for their cooperations and generous participations. QJ was supported by the Natural Science Foundation of Shaanxi Province, China (Grant No. 2013KTZB03-02-01).

Financial support and sponsorship

Research funding to support this study was provided to the investigators' institutions by Novo Nordisk (China) Pharmaceutical Co., Ltd. Q Ji was supported by the Natural Science Foundation of Shaanxi Province, China (Grant No. 2013KTZB03-02-01).

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Zhai FY, Du SF, Wang ZH, Zhang JG, Du WW, Popkin BM. Dynamics of the Chinese diet and the role of urbanicity, 1991-2011. Obes Rev 2014;15 Suppl 1:16-26.  Back to cited text no. 1
[PUBMED]    
2.
Zuo H, Shi Z, Hussain A. Prevalence, trends and risk factors for the diabetes epidemic in China: A systematic review and meta-analysis. Diabetes Res Clin Pract 2014;104:63-72.  Back to cited text no. 2
[PUBMED]    
3.
Li MZ, Su L, Liang BY, Tan JJ, Chen Q, Long JX, et al. Trends in prevalence, awareness, treatment, and control of diabetes mellitus in mainland china from 1979 to 2012. Int J Endocrinol 2013;2013:753150.  Back to cited text no. 3
[PUBMED]    
4.
Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010;87:4-14.  Back to cited text no. 4
[PUBMED]    
5.
Xu Y, Wang L, He J, Bi Y, Li M, Wang T, et al. Prevalence and control of diabetes in Chinese adults. JAMA 2013;310:948-59.  Back to cited text no. 5
[PUBMED]    
6.
Yang W, Lu J, Weng J, Jia W, Ji L, Xiao J, et al. Prevalence of diabetes among men and women in China. N Engl J Med 2010;362:1090-101.  Back to cited text no. 6
[PUBMED]    
7.
Hu D, Fu P, Xie J, Chen CS, Yu D, Whelton PK, et al. Increasing prevalence and low awareness, treatment and control of diabetes mellitus among Chinese adults: The InterASIA study. Diabetes Res Clin Pract 2008;81:250-7.  Back to cited text no. 7
[PUBMED]    
8.
Selvin E, Marinopoulos S, Berkenblit G, Rami T, Brancati FL, Powe NR, et al. Meta-analysis: Glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med 2004;141:421-31.  Back to cited text no. 8
[PUBMED]    
9.
Khaw KT, Wareham N, Bingham S, Luben R, Welch A, Day N. Association of hemoglobin A1c with cardiovascular disease and mortality in adults: The European prospective investigation into cancer in Norfolk. Ann Intern Med 2004;141:413-20.  Back to cited text no. 9
[PUBMED]    
10.
Adler AI, Stratton IM, Neil HA, Yudkin JS, Matthews DR, Cull CA, et al. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): Prospective observational study. BMJ 2000;321:412-9.  Back to cited text no. 10
[PUBMED]    
11.
Cholesterol Treatment Trialists' (CTT) Collaborators, Kearney PM, Blackwell L, Collins R, Keech A, Simes J, et al. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: A meta-analysis. Lancet 2008;371:117-25.  Back to cited text no. 11
    
12.
American Diabetes Association. Standards of medical care in diabetes-2013. Diabetes Care 2013;36 Suppl 1:S11-66.  Back to cited text no. 12
[PUBMED]    
13.
Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycaemia in type 2 diabetes: A patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2012;55:1577-96.  Back to cited text no. 13
[PUBMED]    
14.
Handelsman Y, Mechanick JI, Blonde L, Grunberger G, Bloomgarden ZT, Bray GA, et al. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for developing a diabetes mellitus comprehensive care plan. Endocr Pract 2011;17 Suppl 2:1-53.  Back to cited text no. 14
[PUBMED]    
15.
Society CD. China guideline for type 2 diabetes (2010 edition). Chin J Diabetes 2012;20:s1-37.  Back to cited text no. 15
    
16.
Schroeder EB, Hanratty R, Beaty BL, Bayliss EA, Havranek EP, Steiner JF. Simultaneous control of diabetes mellitus, hypertension, and hyperlipidemia in 2 health systems. Circ Cardiovasc Qual Outcomes 2012;5:645-53.  Back to cited text no. 16
[PUBMED]    
17.
Vouri SM, Shaw RF, Waterbury NV, Egge JA, Alexander B. Prevalence of achievement of A1c, blood pressure, and cholesterol (ABC) goal in veterans with diabetes. J Manag Care Pharm 2011;17:304-12.  Back to cited text no. 17
[PUBMED]    
18.
Shubrook JH Jr., Snow RJ, McGill SL, Brannan GD. “All-or-none” (bundled) process and outcome indicators of diabetes care. Am J Manag Care 2010;16:25-32.  Back to cited text no. 18
    
19.
Varma S, Boyle LL, Varma MR, Piatt GA. Controlling the ABCs of diabetes in clinical practice: A community-based endocrinology practice experience. Diabetes Res Clin Pract 2008;80:89-95.  Back to cited text no. 19
[PUBMED]    
20.
Rossi MC, Nicolucci A, Arcangeli A, Cimino A, De Bigontina G, Giorda C, et al. Baseline quality-of-care data from a quality-improvement program implemented by a network of diabetes outpatient clinics. Diabetes Care 2008;31:2166-8.  Back to cited text no. 20
[PUBMED]    
21.
Bertoni AG, Clark JM, Feeney P, Yanovski SZ, Bantle J, Montgomery B, et al. Suboptimal control of glycemia, blood pressure, and LDL cholesterol in overweight adults with diabetes: The look AHEAD study. J Diabetes Complications 2008;22:1-9.  Back to cited text no. 21
[PUBMED]    
22.
Jackson GL, Edelman D, Weinberger M. Simultaneous control of intermediate diabetes outcomes among Veterans Affairs primary care patients. J Gen Intern Med 2006;21:1050-6.  Back to cited text no. 22
[PUBMED]    
23.
Saydah SH, Fradkin J, Cowie CC. Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. JAMA 2004;291:335-42.  Back to cited text no. 23
[PUBMED]    
24.
Beaton SJ, Nag SS, Gunter MJ, Gleeson JM, Sajjan SS, Alexander CM. Adequacy of glycemic, lipid, and blood pressure management for patients with diabetes in a managed care setting. Diabetes Care 2004;27:694-8.  Back to cited text no. 24
[PUBMED]    
25.
Harris MI. Health care and health status and outcomes for patients with type 2 diabetes. Diabetes Care 2000;23:754-8.  Back to cited text no. 25
[PUBMED]    
26.
Cheung BM, Ong KL, Cherny SS, Sham PC, Tso AW, Lam KS. Diabetes prevalence and therapeutic target achievement in the United States, 1999 to 2006. Am J Med 2009;122:443-53.  Back to cited text no. 26
[PUBMED]    
27.
Ong KL, Cheung BM, Wong LY, Wat NM, Tan KC, Lam KS. Prevalence, treatment, and control of diagnosed diabetes in the U.S. National Health and Nutrition Examination Survey 1999-2004. Ann Epidemiol 2008;18:222-9.  Back to cited text no. 27
    
28.
Li MZ, Ji LN, Meng ZL, Guo XH, Yang JK, Lu JM, et al. Management status of type 2 diabetes mellitus in tertiary hospitals in Beijing: Gap between guideline and reality. Chin Med J (Engl) 2012;125:4185-9.  Back to cited text no. 28
[PUBMED]    
29.
Ji LN, Lu JM, Guo XH, Yang WY, Weng JP, Jia WP, et al. Glycemic control among patients in China with type 2 diabetes mellitus receiving oral drugs or injectables. BMC Public Health 2013;13:602.  Back to cited text no. 29
[PUBMED]    
30.
Yang YN, Xie X, Ma YT, Li XM, Fu ZY, Ma X, et al. Type 2 diabetes in Xinjiang Uygur autonomous region, China. PLoS One 2012;7:e35270.  Back to cited text no. 30
[PUBMED]    
31.
Zhan YQ, Yu JM, Hu DY, Sun YH, Zhang LJ, Fu YY, et al. Prevalence and related knowledge of diabetes mellitus among residents of Beijing. Chin J Public Health 2012;28:19-21.  Back to cited text no. 31
    
32.
Lv SR, Pan XQ, Xiang QY, Wu M. Analysis on the level of plasma glucose and prevalence of diabetes among residents of Jiangsu province. Jiangsu J Prev Med 2011;22:10-2.  Back to cited text no. 32
    
33.
Su N, Wang YD, Chen Q, Gao DH, Yang SB, Liang WN. Community management of patients with hypertension and diabetes in Beijing. Chin J Public Health 2010;7:900-1.  Back to cited text no. 33
    
34.
Zhang PH, Jiao SJ, Zhou Y, Li G, Shi Y, Li H, et al. Studies on prevalence and control of several common chronic diseases among Beijing adults in 2005. Zhonghua Liu Xing Bing Xue Za Zhi 2007;28:625-30.  Back to cited text no. 34
[PUBMED]    
35.
Zhao SH, Chen XY, Wang YG, Yan SL, Li CG, Miao ZM. The investigation of prevalence and risk factors of diabetes mellitus in Shandong coastal area. Chin J Diabetes 2007;15:729-32.  Back to cited text no. 35
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]


This article has been cited by
1 Status of glycosylated hemoglobin and prediction of glycemic control among patients with insulin-treated type 2 diabetes in North China
Jiao Wang,Meng-Yang Wang,Hui Wang,Hong-Wei Liu,Rui Lu,Tong-Qing Duan,Chang-Ping Li,Zhuang Cui,Yuan-Yuan Liu,Yuan-Jun Lyu,Jun Ma
Chinese Medical Journal. 2020; 133(1): 17
[Pubmed] | [DOI]
2 Turkish Nationwide SurvEy of Glycemic and OtherMetabolic Parameters of Patients with Diabetes Mellitus (TEMD Study)
Alper Sonmez,Cem Haymana,Fahri Bayram,Serpil Salman,Oguzhan Sitki Dizdar,Eren Gurkan,Ayse Kargili Carlioglu,Cem Barcin,Tevfik Sabuncu,Ilhan Satman
Diabetes Research and Clinical Practice. 2018;
[Pubmed] | [DOI]
3 Prevalence, treatment patterns and control rates of metabolic syndrome in a Chinese diabetic population: China Cardiometabolic Registries 3B study
Yali Jing,Ting Hong,Yan Bi,Dayi Hu,Guojuan Chen,Jihu Li,Ye Zhang,Ruya Zhang,Linong Ji,Dalong Zhu
Journal of Diabetes Investigation. 2018;
[Pubmed] | [DOI]



 

Top
  
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
   Conclusion
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed1543    
    Printed32    
    Emailed0    
    PDF Downloaded176    
    Comments [Add]    
    Cited by others 3    

Recommend this journal