JDMJournal of Diabetes Mellitus2160-5831Scientific Research Publishing10.4236/jdm.2013.33023JDM-35167ArticlesMedicine&Healthcare Importance of regional differences in the features of type 2 diabetes mellitus in one and the same country—The example of Thailand upattraSrivanichakorn1TassaneeYana1PattaraSanchaisuriya2YuYu Maw3FrankPeter Schelp4*Institute of Tropical Medicine, Charité—University Medicine Berlin, Berlin, GermanyDepartment of Nutrition, Faculty of Public Health, Khon Kaen University, Khon Kaen, ThailandASEAN Institute for Health Development, Mahidol University, Bangkok, ThailandFaculty of Public Health, Khon Kaen University, Khon Kaen, Thailand* E-mail:f_schelp@kku.ac.th(FPS);17072013030315015514 June 201312 July 2013 19 July 2013© Copyright 2014 by authors and Scientific Research Publishing Inc. 2014This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/

Background: A dataset from a nationwide assessment of type 2 diabetes mellitus (T2DM) patients fromThailandwas reassessed. Objective: Prevalence of T2DM is highest in the northeast ofThailandand the intention of the study was to assess whether the clinical picture and behavior of patients from the northeast differ from the rest of the country. Materials and Methods: The variables of two groups of patients i.e. those from the northeast ofThailandand patients from the remaining three other regions, with the exception ofBangkok, were compared. The dataset consisted out of clinical laboratory data and the results of a questionnaire recording knowledge and admitted compliance of patients. Results: A higher proportion of patients from the northeast have elevated triglyceride levels and lower high density lipoprotein (HDL) fractions in comparison with the patients derived from the other three regions. The northeasterners know very well and better than the patients of the other regions how to take care of them while having T2DM yet the proportion of those with glycated hemoglobin (HbA1c) values over 6.4% was higher for them than for the other group of patients. Conclusion: In depth investigation by health educators would be useful in order to find out how the relationship between knowledge and practice could be improved for patients from the northeast of Thailand.

Diabetes; Patients; Compliance; Thailand1. INTRODUCTION

The health delivery system of middle income countries like Thailand is challenged by chronic diseases, while also still dealing with problems related to infectious illnesses [1]. The prevention of diseases requires the compliance of the population at risk which is especially true for primary and secondary prevention of chronic diseases such as type 2 diabetes mellitus (T2DM) [2]. It is important for health authorities to consider also regional and local differences in the risk factor for T2DM and the behavioral pattern of different population groups within one and the same country under their responsibility in order to adequately implement measures for primary and secondary prevention to cope with T2DM. Thailand commonly is dived in four regions with distinctive geographical and cultural differences. From all the four regions of the country the prevalence of T2DM in the northeast exceeds the other three regions [3]. In a foregoing publication [4] the laboratory results from over 4000 patients with T2DM from all over Thailand was reported. A questionnaire also assessed from a subsample of approximately 2800 individuals investigated how patients understand the character of the disease they are suffering from and how they observe the advice given to them in terms of taking medicine and taking appropriate care of them. Ninety percent of the patients claimed that they took their medicine as told and 80% seemed to know well how to take care of them. Sixty percent of all the patients, from whom the sub-sample had been takenhad glycated hemoglobin (HbA1c) levels above 7% in addition to the high proportion of patients with high triglyceride and low high density lipid (HDL) levels [4]. Obviously, the result of the questionnaire contradicted the laboratory findings and the situation of T2DM patients in Thailand was not as favorable as the results of the questionnaire seemed to imply. The data set, the foregoing investigation was based upon, was re-assessed for this contribution in comparing the results obtained from T2DM patients from the northeast of Thailand with the combined results from the patients of the other three regions with the exception of Bangkok. The objective of this study was to find out whether the higher prevalence of T2DM in the northeast in comparison with the rest of Thailand is due to differences in the clinical features of the patients indicated by the laboratory results and aggravated by a lower health status of the patients somehow masked by the false impression of a good compliance there.

2. MATERIALS AND METHODS

Laboratory results from approximately 4832 T2DM patients had been derived from 11 provinces of Thailand. A sub-sample of 2892 patients answered a questionnaire. Details of the sampling technique are given in the preceding publication [4]. Laboratory variables as well as weight and height data were used from the last visit of the patients to the respective health provider at the end of the project.

The results derived from the blood of the patients are based on the determination undertaken in a Bangkok central laboratory and details about the methods used and transforming the results into categories by setting cutoff points are given in a previous publication as well [5]. A change was made from the foregoing procedures in categorizing glycated hemoglobin (HbA1c) according to recent suggestions to use as cutoff point 6.5% in order to identify “abnormal” values [6].

The second and the third category refer to the first and the third quartile of the distribution of HbA1c for all patients under survey. In the case of three categories for the clinical laboratory findings the data had been collapsed to two categories taken the first category as 1 in the binary multivariate assessment. For data management and statistical analysis the Minitab statistical software version 12 was used and procedures in general were followed as explained in the foregoing publications [4,5].

The study was approved by the Ethical Review Committee for Research in Human Subjects, Faculty of Medicine, Ramathibodee Hospital, Mahidol University, Bangkok, Thailand.

3. RESULTS

Table 1 displays the proportion of females and males

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