A hospital-based case-control study in Mueang Phitsanulok compared 130 patients with physician-diagnosed microvascular complications and 260 controls. Diabetes for at least seven years, blood pressure of 140/90 mmHg or higher and high stress were associated with complications. The extremely large association for no metformin use had a very wide CI and cannot establish a direct protective drug effect.
Key findings
- Diabetes duration of at least seven years was associated with complications (aOR 3.05, 95% CI 1.52–6.15).
- Blood pressure of at least 140/90 mmHg had an aOR of 2.55 (95% CI 1.40–4.65), and high stress an aOR of 2.18 (95% CI 1.01–4.74).
- No metformin use had an aOR of 108.02 (95% CI 21.92–532.25), and no glipizide use an aOR of 2.83 (95% CI 1.59–5.06).
- Age above 60 showed an inverse association (aOR 0.20, 95% CI 0.11–0.37); HbA1c and diet were not significant after adjustment.
Why this matters globally
The findings support monitoring disease duration, blood pressure and psychosocial stress alongside diabetes care, and examining medication-access gaps. Prospective data and control for confounding by indication are needed to estimate specific drug effects.
Thai researcher contribution
Researchers from the Primary Care Center at Buddhachinaraj Phitsanulok Hospital, the Department of Environmental Health at the University of Phayao's School of Public Health, and Sirindhorn College of Public Health Phitsanulok under the Praboromarajchanok Institute used real-world Phitsanulok data to identify service-level surveillance priorities.
Limitations to consider
A single-setting case-control design cannot establish temporality and is vulnerable to selection, recall and confounding by indication. The aOR of 108.02 with a very wide CI suggests sparse data or baseline differences. The inverse age association may reflect survivor bias.