Effectiveness of primary care-based chronic disease management program on glycated hemoglobin levels

Abstract

Abstract Background: Diabetes is one of the most common causes of cardiovascular disease and has led to death over time. For better management of glycated hemoglobin levels, which is a well-known index in diagnosing diabetes, many countries have been launching chronic disease management programs. Therefore, this study aimed to evaluate the effectiveness of the primary care-based chronic disease management integrated pilot program (PCDMP) in controlling glycated hemoglobin (HbA1c) levels in Korea. Nation-wide data from the 2019–2021 Korea National Health and Nutrition Examination Survey were used. Methods: We analyzed nationwide health examination data combined with various regional data sources. Using appropriate inclusion criteria for this study, a total of 13,901 individuals were suitable for the analysis. A generalized linear mixed model was applied to consider the clustered structure of the regional level data, where individual-level data, containing demographic characteristics and health-related information, were nested. Results: Individuals living in areas with a low PCDMP participation (< 30.37%) had odds (95% CI, 1.08–1.82) of exhibiting glycated hemoglobin levels ≥ 6.5% greater than did those residing in areas with a high PCDMP participation (≥ 30.37%). According to the stratified analysis of HbA1c levels, people residing in areas with low PCDMP participation had significantly greater odds of having an HbA1c > 6.5%, which may indicate diabetes mellitus. Conclusion: The lower the number of internal medicine clinics in an area participating in PCDMP was, the greater the possibility of an HbA1c > 6.5%. Our findings advocate the need for the government to pay attention to chronic disease management programs, which may lead individuals to have normal HbA1c levels (< 6.5%).