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Chasms in Achievement of Recommended Diabetes Care among Geographic Regions in Korea.

  • Cho, Sanghyun1
  • Shin, Ji Yeon2
  • Kim, Hyun Joo3
  • Eun, Sang Jun4
  • Kang, Sungchan5
  • Jang, Won Mo6
  • Jung, Hyemin1, 6
  • Kim, Yoon1, 7
  • Lee, Jin Yong1, 8
  • 1 Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea. , (North Korea)
  • 2 Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, Korea. , (North Korea)
  • 3 Department of Nursing Science, Shinsung University, Dangjin, Korea. , (North Korea)
  • 4 Department of Preventive Medicine, Chungnam National University School of Medicine, Daejeon, Korea. , (North Korea)
  • 5 Department of Public Health Science, School of Public Health, Seoul National University, Seoul, Korea. , (North Korea)
  • 6 Health Review and Assessment Committee, Health Insurance Review and Assessment Service, Wonju, Korea. , (North Korea)
  • 7 Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea. , (North Korea)
  • 8 Department of Public Health and Community Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea. [email protected] , (North Korea)
Published Article
Journal of Korean medical science
Publication Date
Aug 12, 2019
DOI: 10.3346/jkms.2019.34.e190
PMID: 31392852


Although effective care for type 2 diabetes (T2DM) is well known, considerable inadequate care has been still existed. Variations in achievement of the recommended quality indicators inT2DM care among small areas are not well known in Korea. This study examined the quality of care T2DM care and its geographical variations. We used the national health insurance database and national health screening database. Seven quality indicators were used to evaluate continuity of care (medication possession ratio), process of care (hemoglobin A1c test, lipid profile, microalbuminuria test, and eye examination), and intermediate outcome (blood pressure control, and low-density lipoprotein control). Crude and age-standardized proportions were calculated for each 252 districts in Korea. All quality indicators failed to achieve the recommended level. Only about 3% and 15% of the patients underwent eye examination and microalbuminuria test, respectively. Other indicators ranged from 48% to 68%. Wide variation in the quality existed among districts and indicators. Eye examination and microalbuminuria test varied the most showing tenfold (0.9%-9.2%) and fourfold (6.3%-28.9%) variation by districts, respectively. There were 32.4 and 42.7 percentage point gap between the best and the worst districts in hemoglobin A1c test and blood pressure control, respectively. Considerable proportion of T2DM patients were not adequately managed and quality of care varied substantially district to district. To improve the quality of diabetes care, it is necessary to identify the poor performance areas and establish a well-coordinated care system tailored to the need of the district. © 2019 The Korean Academy of Medical Sciences.

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