Achievement of Metabolic Goals among Different Health Insurance Schemes in Thai Patients with Type 2 Diabetes Mellitus: a Nationwide Study

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Lukana Preechasuk
Pimrapat Tengtrakulcharoen
Khemajira Karaketklang
Ram Rangsin
Tada Kunavisarut


Objective: Thailand has three healthcare insurance schemes, including: Universal Health Coverage (UHC), Social Health Insurance (SHI), and Civil Servant Medical Benefit (CSMB). UHC has the narrowest drug coverage, SHI uses its own list, and CSMB offers the greatest drug coverage. The aim of this study was to investigate metabolic goal achievement in patients with type 2 diabetes mellitus (T2DM) compared among the three healthcare schemes in Thailand.
Methods: Data were obtained from a nationwide survey administered by MedResNet during 2011 to 2012. A cross-sectional survey was conducted in patients with T2DM aged >35 years who were treated for at least 12 months. The data were retrospectively collected from medical records.
Results: Of 49,303 T2DM patients that were recruited, 69.8% were female. CSMB patients were the oldest and had the longest diabetes duration. Achievement of BP, HbA1c, and LDL goals was 32.8%, 33.3%, and 42.5%, respectively. UHC patients had the highest percentage of BP control achievement (<130/80 mmHg; 33.1%), while CSMB patients had the highest percentage of HbA1c (<7%; 40.4%) and LDL (<100 mg/dL; 49%) achievement. CSMB patients had the highest prevalence of 2-goal (16.8% for T2DM without HT) and 3-goal achievement (8.2% for T2DM with HT). Multivariate analysis revealed the CSMB scheme to be significantly associated with 3-goal achievement compared to the UHC scheme (odds ratio: 1.48, 95% confidence interval: 1.30-1.67; p<0.01).
Conclusion: The prevalence of metabolic goal achievement in patients with T2DM in Thailand is low. CSMB patients have the highest prevalence of 2-goal and 3-goal achievement.


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Preechasuk, L., Tengtrakulcharoen, P., Karaketklang, K., Rangsin, R., & Kunavisarut, T. (2019). Achievement of Metabolic Goals among Different Health Insurance Schemes in Thai Patients with Type 2 Diabetes Mellitus: a Nationwide Study. Siriraj Medical Journal, 72(1), 1–9.
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1. International Diabetes Federation. IDF Diabetes Atlas, 8th eds. Brussels, Belgium: International Diabetes Federation; 2017.
2. Gæde P, Vedel P, Larsen N, Jensen GV, Parving H-H, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 2003;348:383-93.
3. Gæde P, Lund-Andersen H, Parving H-H, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med 2008;358:580-91.
4. Rawshani A, Rawshani A, Franzen S, Eliasson B, Svensson AM, Miftaraj M, et al. Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes. N Engl J Med 2017;376:1407-18.
5. Cheng YJ, Imperatore G, Geiss LS, Saydah SH, Albright AL, Ali MK, et al. Trends and Disparities in Cardiovascular Mortality Among U.S. Adults With and Without Self-Reported Diabetes, 1988-2015. Diabetes Care 2018;41:2306-15.
6. Gregg EW, Li Y, Wang J, Burrows NR, Ali MK, Rolka D, et al. Changes in diabetes-related complications in the United States, 1990-2010. N Engl J Med 2014;370:1514-23.
7. American Diabetes A. Economic Costs of Diabetes in the U.S. in 2017. Diabetes Care 2018;41:917-28.
8. Quick JD. Ensuring access to essential medicines in the developing countries: a framework for action. Clinical Pharmacology & Therapeutics 2003;73:279-83.
9. Tangcharoensathien V, Witthayapipopsakul W, Panichkriangkrai W, Patcharanarumol W, Mills A. Health systems development in Thailand: a solid platform for successful implementation of universal health coverage. Lancet 2018;391:1205-23.
10. Prevention I. Standards of medical care in diabetes—2011. Diabetes Care 2011;34:S11.
11. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018;39:3021-104.
12. Davies MJ, D'Alessio DA, Fradkin J, Kernan WN, Mathieu C, Mingrone G, et al. Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2018;61:2461-98.
13. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2018.p.25709.
14. Kumar KH, Modi K. A1c, blood pressure and cholesterol goal achievement in patients of Type 2 diabetes. Medical Journal of Dr DY Patil University. 2016;9(2):195.
15. Belay E, Abera A, Mehari A, Gebremeskel G, Endrias A, Endris K. Achievements of Diabetes Goals and Their Determinants in Type 2 Diabetic Patients Attending Outpatient Diabetic Clinic in Northern Ethiopia. Int J Chronic Dis 2017;2017:5713187.
16. Ali MK, Bullard KM, Saaddine JB, Cowie CC, Imperatore G, Gregg EW. Achievement of goals in U.S. diabetes care, 1999-2010. N Engl J Med 2013;368:1613-24.
17. Yu SH, Kang JG, Hwang YC, Ahn KJ, Yoo HJ, Ahn HY, et al. Increasing achievement of the target goals for glycemic, blood pressure and lipid control for adults with diagnosed diabetes in Korea. J Diabetes Investig 2013;4:460-5.
18. Kosachunhanun N, Benjasuratwong Y, Mongkolsomlit S, Rawdaree P, Plengvidhya N, Leelawatana R, et al. Thailand diabetes registry project: glycemic control in Thai type 2 diabetes and its relation to hypoglycemic agent usage. J Med Assoc Thai 2006;89 Suppl 1:S66-71.
19. Shi Q, Liu S, Krousel-Wood M, Shao H, Fonseca V, Shi L. Long-term outcomes associated with triple-goal achievement in patients with type 2 diabetes mellitus (T2DM). Diabetes Res Clin Pract 2018;140:45-54.
20. Rawshani A, Rawshani A, Franzen S, Sattar N, Eliasson B, Svensson AM, et al. Risk Factors, Mortality, and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med 2018;379:633-44.
21. Patcharanarumol W, Panichkriangkrai W, Sommanuttaweechai A, Hanson K, Wanwong Y, Tangcharoensathien V. Strategic purchasing and health system efficiency: A comparison of two financing schemes in Thailand. PLoS One 2018;13:e0195179.
22. De Berardis G, Pellegrini F, Franciosi M, Belfiglio M, Di Nardo B, Greenfield S, et al. Quality of care and outcomes in type 2 diabetic patients: a comparison between general practice and diabetes clinics. Diabetes Care 2004;27:398-406.
23. Arai K, Hirao K, Matsuba I, Takai M, Matoba K, Takeda H, et al. The status of glycemic control by general practitioners and specialists for diabetes in Japan: a cross-sectional survey of 15,652 patients with diabetes mellitus. Diabetes Res Clin Pract 2009;83:397-401.

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