Population-based study reveals substantial attrition in diabetes follow-up care and glycemic control in adults, highlighting systemic bottlenecks and practice-level inequalities.
Key Points
To assess the continuum of type 2 diabetes care using an extended cascade incorporating guideline-recommended follow-up indicators and identify patient- and practice-level determinants of care.
Analyzed cross-sectional data from national health insurance records and the Health Examination Survey among adults aged ≥ 40 years.
Used longitudinal health insurance data from a cohort with type 2 diabetes to evaluate individual- and practice-level determinants via within-between random effects logistic regression models.
Diabetes prevalence was 11.9%; among individuals with diabetes, 93.7% were tested, 77.9% diagnosed, 75.9% linked to care, and 45.4% achieved glycaemic control.
Follow-up adherence varied substantially: 69.8% received annual serum creatinine tests, 47.1% were prescribed statins, 46.0% had at least two HbA1c checks, and 24.1% received an eye examination.
Better follow-up care was associated with older age, eligibility for increased reimbursement, higher comorbidity burden, and receiving primary care in group or capitation-based practices rather than single-handed fee-for-service clinics.