Continuity of Patient Care ; Humans ; Models, Nursing ; Practice Patterns, Nurses' ; Singapore

INTRODUCTIONThe National Healthcare Group (NHG) launched an enterprise-wide diabetes registry in 2007. We describe the epidemiology of type 2 diabetes mellitus from 2005 to 2008.

MATERIALS AND METHODSPatients with encounters in NHG from 2005 were identified for inclusion into the Diabetes Registry from existing stand-alone diabetes registries, ICD9CM diagnosis codes, anti-hyperglycaemic medication and laboratory confirmation. Variables extracted for analysis were demographics (age, gender, ethnicity), diabetes-related comorbidities and complications, most recent anti-hyperglycaemic agents dispensed, and the most recent glycated haemoglobin (HbA1C) measurement.

RESULTSThe diabetes registry grew 32% from 129,183 patients in 2005 to 170,513 patients in 2008, making up 12% to 15% of all patients in NHG. About half of the type 2 diabetes patients were aged 45 to 64 years. Females were generally older with a median age of 63 to 64 years vs 59 to 61 years in males. The Indian ethnic group accounted a disproportionately higher 13% of patients. Over 95% of type 2 patients had at least one diabetes-related comorbid condition, and diabetes-related complications were principally renal and cardiovascular complications. The majority (86.2% to 89.2%) of primary care patients were on oral anti-hyperglycaemic agents; however, the rate of insulin treatment increased from 10.8% to 13.8%. HbA1C levels in 2008 improved over that in 2005, with the percentage of patients with good glycaemic control improving with age.

CONCLUSIONThe registry has enabled a baseline assessment of the burden and the care of type 2 diabetes patients in NHG, which will provide critical "evidence" for planning future programmes.

Administration, Oral ; Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Comorbidity ; Diabetes Mellitus, Type 2 ; drug therapy ; epidemiology ; Female ; Humans ; Hypoglycemic Agents ; administration & dosage ; Injections, Intramuscular ; Male ; Middle Aged ; Registries ; Sex Distribution ; Singapore ; epidemiology

INTRODUCTIONThis study aims to measure the quality of care for patients with diabetes mellitus at selected Specialist Outpatient Clinics (SOCs) in the National Healthcare Group.

MATERIALS AND METHODSThe cross-sectional study reviewed case-records of patients from 6 medical specialties who were on continuous care for a minimum of 15 months from October 2003 to April 2005. Disproportionate sampling of 60 patients from each specialty, excluding those co-managed by Diabetes Centres or primary care clinics for diabetes, was carried out. Information on demographic characteristics, process indicators and intermediate outcomes were collected and the adherence rate for each process indicator compared across specialties. Data analysis was carried out using SPSS version 13.0.

RESULTSA total of 575 cases were studied. The average rate for 9 process indicators by specialty ranged from 47.8% to 70.0%, with blood pressure measurement consistently high across all specialties (98.4%). There was significant variation (P <0.001) in rates across the specialties for 8 process indicators; HbA1c, serum creatinine and lipid profile tests were over 75%, while the rest were below 50%. The mean HbA1c was 7.3% +/- 1.5%. "Optimal" control of HbA1c was achieved in 51.2% of patients, while 50.6% of the patients achieved "optimal" low-density lipoprotein (LDL)-cholesterol control. However, 47.3% of patients had "poor" blood pressure control. Adherence to process indicators was not associated with good intermediate outcomes.

CONCLUSIONSThere was large variance in the adherence rate of process and clinical outcome indicators across specialties, which could be improved further.

Adult ; Aged ; Aged, 80 and over ; Cholesterol, LDL ; Cross-Sectional Studies ; Diabetes Mellitus ; therapy ; Female ; Glycated Hemoglobin A ; Hospitals, Public ; Humans ; Male ; Middle Aged ; Outcome Assessment (Health Care) ; Outpatient Clinics, Hospital ; Outpatients ; Patient Acceptance of Health Care ; Patient Compliance ; Quality of Health Care ; Retrospective Studies ; Singapore

INTRODUCTIONThis study aims to determine the association of geriatric syndromes and depressed mood among respondents with diabetes in a lower income community; and their association with self-management, lifestyle behaviour, and healthcare utilisation. This paper focuses primarily on the 114 respondents with diabetes aged 50+ to inform policy formulation at the community level.

MATERIALS AND METHODSA pilot community health assessment was conducted in 4 blocks of 1- and 2-room apartments in Toa Payoh district from July to November 2009. Using a standard questionnaire, interviewers conducted face-to-face interviews with household members on chronic diseases, geriatric syndromes and health-related behaviour. Data were analysed using SPSSv15.

RESULTSA total of 795 respondents were assessed with a response rate of 61.8%. Of 515 (64.8%) aged 50+ analysed in this study, 22.1% reported having diabetes, of whom 31.6% reported being depressed. Respondents with diabetes who reported being depressed had a higher prevalence of geriatric syndromes compared with those non-depressed; i.e. functional decline (30.6% vs 5.1%, P <0.001); falls (33.3% vs 10.3%, P = 0.003); stumbling (30.6% vs 10.3%, P = 0.007); urinary incontinence (33.3% vs 5.1%, P <0.001), progressive forgetfulness (27.8% vs 6.4%, P = 0.002) and poor eyesight (22.2% vs 6.4%, P = 0.014). They were less likely to comply with medications (86.1% vs 97.3%, P = 0.026) and performed exercise (13.9% vs 53.8%, P <0.001). More had hospital admissions (13.9% vs 7.7%); and they had more outpatient visits per person (2.4 visits vs 0.9 visits, P = 0.03) at Specialist Outpatient Clinics.

CONCLUSIONGeriatric syndromes were associated with the presence of depressed mood among persons with diabetes in the lower income group. As those with depressed mood had more unfavourable self-management and lifestyle behaviour, and utilise higher healthcare services, diabetes management must take these findings into consideration.

Activities of Daily Living ; Aged ; Depression ; epidemiology ; Diabetes Mellitus ; drug therapy ; psychology ; Disease Management ; Female ; Health Behavior ; Health Promotion ; Health Services ; utilization ; Humans ; Interviews as Topic ; Life Style ; Male ; Middle Aged ; Patient Acceptance of Health Care ; Poverty ; Singapore ; epidemiology ; Surveys and Questionnaires