Comparative studies of treatment outcomes for diabetic patients between Primary Care Cluster (PCC) San Po and Primary Care Service Network, Mae-ai district, Chiang Mai Province

Abstract

Diabetic mellitus is a non-communicable disease with a steadily increasing prevalence to date. Treatment has performed appropriately providing so far for crucially minimizing the complications. According to limitation of medical resources, it has not been feasible to manage all patients in the hospital solely. Consequently, referrals to Primary Care Cluster (PCCs) and Sub-district Health Promoting Hospitals (SHPHs) have been often implemented to enhance accessible patient care. An objective of this study was to conduct a comparative cross-sectional descriptive study of blood glucose levels and incidence of diabetic mellitus complications between patients treated at PCCs, Non-Communicable Disease (NCD) Clinics, and SHPHs. Collection of data was retrospectively retrieved from electronic medical records and laboratory test results in the fiscal year 2024. The units of study included 156 patients from each health care unit, accounted totally for 468 clients. The results revealed the PCCs demonstrated a higher capacity to manage patients with co-morbidities and prescribed more medications compared to that of the SHPHs. Average fasting blood sugars (FBS) levels were lower in the PCCs (125.87 mg/dL) than that in the NCD clinics (136.81 mg/dL), and SHPHs (127.6 mg/dL). While HbA1C levels showed no significant differences across the health care units, the PCCs achieved better urine microalbumin levels than that of the NCD clinics (50.38 vs. 64.74 mg/L), whereas it was slightly higher levels than that of the SHPHs (47.50 mg/L). The estimated glomerular filtration rate (eGFR) levels showed no significant differences, while the PCCs recorded better low-density lipoprotein (LDL) levels (72.08 mg/dL) when compared to that of the SHPHs (77.04 mg/dL) and the NCD clinics (88.76 mg/dL). Short-term complications, such as hypoglycemia, hyperglycemia, infections, and wounds, were similar across the three units. However, long-term complications, such as cerebrovascular disease, were most prevalent in the NCD clinics (9.6%), followed by the PCCs (5.1%) and the SHPHs (1.2%), respectively. Similarly, a coronary artery disease incidence was highest in the NCD clinics (5.8%), came after by the PCCs (5.0%) and the SHPHs (0%). The research conclusion implied that the PCCs demonstrated a higher capability in managing patients with complex conditions when compared to capability of the SHPHs while maintaining a better care efficiency.