Comparison in diabetes-related complications for inpatients among university medical centers, regional hospitals and district hospitals

Objectives: The purpose of this study was to investigate and compare the rate of chronic complications for diabetic inpatients among three levels of medical facilities. Diabetic care and patients' self-homecare behaviors were also investigated. Methods: A total of 456 inpatients with diabetes mellitus were recruited from 4 university medical centers (UMC), 3 regional hospitals (RH) and 6 district hospitals (DH) in Taiwan, during June 2000 and May 2001. Patients were interviewed for information in demographic characteristics and health care behaviors. Medical records were reviewed for diabetic care provided to patients and diabetes-related complications diagnosed for them. Results: Patients have been hospitalized for approximately 4 events in average. No significant difference was found in the rates of cardiovascular disease (49.2%-55.1%), nephropathy (43.8%-57.4%) and cerebrovascular disease (18.9-28.1%) for hospitalized patients, among the 3 levels of hospital. While the UMC inpatients had the highest prevalence rates of diabetic foot (16.2%) and neurophathy (33.5%), the RH inpatients had the highest rate of retinopathy (46. 0%). The rate of regular follow-up check was the lowest (66.4%) for inpatients of DH. They were also less likely than patients of UMC and RH to have self-monitoring of plasma sugar or urine sugar. Conclusions: A good proportion of diabetes inpatients have multiple diabetes-related complications with frequent hospitalizations. Patients cared at DH need greater attention in diabetic care than that at UMC and RH. Standard diabetes care protocol for complication prevention should be implemented.