Abstract：
Improved diabetes management in primary care is essential for reducing the public health burden of diabetes, and various programs are being implemented in Korea for this purpose. Although the Health Insurance Review and Assessment (HIRA) evaluates the quality of type 2 diabetes management in primary care clinics and hospitals, it is unclear whether the implementation of these evaluations is related to the adequate management of complications in diabetic patients. We evaluated the association between the proportion of clinics managing diabetes well and lifestyles and uptake of screening for complications in 24,620 diabetic participants of the 2019 Korean Community Health Survey (KCHS). Multivariate multilevel logistic regression was performed to evaluate the fixed effect of the district-level variable and the heterogeneity among districts. The proportion of clinics with good diabetes management per 10,000 inhabitants was positively related to screening for diabetes complications. Furthermore, this district variable was significantly related to engaging in walking activity (Odds ratio: 1.39, 95% CI: 1.10-1.76) and sufficiently explained the heterogeneity among districts. However, current smoking and weight control were not associated with the proportion of clinics with good diabetes management. The financial incentives to primary care clinics would improve the primary prevention of diabetic complications.
摘要：
改善初级保健中的糖尿病管理对于减轻糖尿病的公共卫生负担至关重要。为此，韩国正在实施各种计划。尽管健康保险审查和评估（HIRA）评估了初级保健诊所和医院的2型糖尿病管理质量，目前尚不清楚这些评估的实施是否与糖尿病患者并发症的适当管理有关.我们评估了2019年韩国社区健康调查（KCHS）的24,620名糖尿病参与者中糖尿病管理良好的诊所比例与生活方式和并发症筛查之间的关系。采用多因素多水平logistic回归评价区级变量的固定效应和区际异质性。每10,000名居民中糖尿病管理良好的诊所比例与糖尿病并发症筛查呈正相关。此外，该地区变量与参与步行活动显著相关(几率:1.39,95%CI:1.10-1.76),并充分解释了地区间的异质性.然而,目前吸烟和体重控制与糖尿病管理良好的诊所比例无关.对初级保健诊所的财政激励将改善糖尿病并发症的初级预防。
