Abstract
BACKGROUND: Glycemic and cardiovascular risks control in patients with type 2 diabetes (T2DM) managed in primary healthcare (PHC) settings remains challenging in urbanizing areas like Guangzhou. This study analyzes 2018-2022 trends to identify care gaps and inform policy. METHODS: We collected and analyzed real-world data (RWD) from 81,709 adults aged 30 years or older with T2DM who voluntarily participated in health examinations across 24 primary healthcare settings in Baiyun district, Guangzhou. The assessed targets included fasting blood glucose(FBG), blood pressure (BP), lipid panel with total cholesterol(TC), triglycerides(TG),low-density lipoprotein(LDL) and high-density lipoprotein(HDL), and BMI. Associated factors encompassed socioeconomic and lifestyle variables, and anthropometric measurement as waist circumference (WC). Linear and logistic regression models were used to analyze the trend in the percentage of participants with clinical target achievements and associated factors. RESULTS: The study population comprised predominantly older female participants with prolonged diabetes duration and high hypertension comorbidity prevalence (87.6%).Trends in the standardized percentage of participants with control of FG, TC, TG, LDL, and BMI were improved; however, those for BP and HDL decreased from 2018 to 2022 (p<0.05). Lifestyle modifications presented a paradoxical pattern: despite alcohol, diet, physical activity were improved, smoking (+2.8%) and waist circumference (WC, +0.7cm) increased significantly. Patients with uncontrolled FG, BP, and LDL were less physically active if older, female, or single, while those with higher WC more often had unhealthy lifestyles and poorer metabolic control. CONCLUSION: While metabolic parameters improved, suboptimal BP and HDL control reveal ongoing primary care challenges.Advanced age, female sex, longer diabetes duration, unmarried status, and increased WC are key barriers to uncontrolled FG, BP, and LDL. The findings highlight the need to prioritize enhanced BP and HDL control strategies and implement precision lifestyle interventions for high-risk patient subgroups in PHC.