2018 Quality Survey of Diabetes Health Promotion Institutes in Taiwan - Diabetes Kidney Disease

Background: Since the Diabetic Health Promotion Institution (DPHI) was first set up in 1989, the Taiwan Diabetes Shared Care Network (DSCN) has been well-established in recent decades. This cross-sectional study is conducted to evaluate the quality of diabetes care and get a closer look at the epidemiology of diabetes patient in Taiwan. Methods: This survey was conducted in 40 Diabetes Health Promotion Institutes in 2018. Diabetes subjects who regularly visited the same institute for at least 1 year were selected by one per every 5 consecutive visits. Results: There were 5,720 patients with Type2 diabetes and more than 18 years old enrolled in study. After excluded the missing information of nephropathy (n=1,942), there were 3,778 patients accessed in this study, and they who had nephropathy would be separated to stage I (n=1,132), stage II (n=1,510), stage Ilia (n=653), stage 1Mb (n=301), stage IV (n=120), and stage V + hemodialysis (HD)+peritoneal dialysis (PD) (n=62). Patients' median age was 65 (IQR 57-71) years, and the majority were non-smoker (73.8%), and had BMI s27 kg/m2 (39.3%), A1C s7% (56.3%), and medication use for diabetes (95.5%). In the multivariate analysis, sex (male > female), cigarette smoking (stage Ilia: aOR, 1.78; 95% CI: 1.24-2.56), hypertension drugs (stage ll-V+HD+PD: aOR, 1.44 to 5.43), hyperlipidemia drugs (stage II, aOR, 1.42; 95% CI: 1.17-1.74), insulin (stage llla~V+HD+PD: aOR, 1.71 to 5.18), and neuropathic pain score had significant relationship of higher risk of DM nephropathy. Patients attended nursing health education had lower risk than patients without attending nursing health education (stage ll-V+HD+PD: aOR 0.03-0.61). Conclusions: Among the patients receiving diabetes care in DPHI, factors, including sex, cigarette smoking, hypertension and hyperlipidemia drugs, neuropathic pain score, and nursing health education, were observed to have significant relationship with nephropathy for some of stages. Understanding the epidemiology and risks factors of DM nephropathy can inspire us with further treatment strategy to improve the quality of diabetes care.