Diabetes and social conditions in Estonia. A population-based study

BACKGROUND: The aim of this study was to investigate aspects of metabolic control, treatment and complications as well as quality of life in patients with diabetes mellitus from a defined population in Estonia. METHODS: We invited 220 randomly selected diabetes patients recruited to a clinical investigation from a local diabetes register of 1,100 patients in Viljandi, Estonia. The main outcome measures were derived from medical history, physical examination (height, weight and blood pressure), laboratory variables (blood glucose and glycated haemoglobin A1 (HbA1 normal reference range 3.2-5.6%), serum total and HDL cholesterol and creatinine), a questionnaire on disease-related knowledge and quality of life variables. RESULTS: In all, 181 diabetes patients were investigated, of whom 90% were diagnosed with type 2 diabetes. The mean diabetes duration was 8.9 years from clinical diagnosis and mean HbA1 level was 7.3%. The overall proportion of patients treated with insulin was 29.8% and with anti-hypertensive drugs 26.5%. Smoking was present in 14.3%. The proportion of patients with various diabetes complications was high (73.5%), mostly consisting of different manifestations of cardiovascular disease. Foot ulcers or gangrene were observed in 11.6%. A low level of quality of life was registered in many patients, mostly due to difficult living conditions. CONCLUSIONS: Diabetes patients in Viljandi showed an acceptable degree of glucose metabolic control, but reported a high degree of diabetes complications, as well as impaired quality of life. The diabetes complications may therefore be due to detrimental factors other than hyperglycaemia, e.g. the standard of care during previous years as well as current social and living conditions.