Дисертації з теми "Newly diagnosed type 2 diabete"

Introduzione. Negli ultimi anni sono stati individuati molti nuovi polimorfismi (SNP, Single Nucleotide Polymorphisms) associati allo sviluppo di diabete di tipo 2 (T2DM), soprattutto grazie all’avvento di nuove tecniche di genotipizzazione su larga scala, GWAS (Genome Wide Association Scan). Ogni SNP però contribuisce da solo in modo marginale al rischio di sviluppare la malattia e spesso è poco chiara la funzione biologica di queste varianti geniche nella regolazione dell’omeostasi del glucosio. Tra questi polimorfismi, la variante intronica rs7903146 del gene TCF7L2 (Transcription Factor 7 Like 2) è al momento il più forte fattore di rischio per il diabete di tipo 2 (O.R.= 1.37). Scopo dello studio. Chiarire l’effetto di diversi loci associati allo sviluppo di T2DM su fenotipi clinici e patofisiologici (funzione beta-cellulare e sensibilità insulinica) in pazienti con T2DM neo-diagnosticato. Metodi. Abbiamo analizzato 464 pazienti di discendenza italiana con T2DM neodiagnosticato, anti-GAD negativi. La caratterizzazione clinica standard è stata effettuata mediante metodi classici. La funzione beta-cellulare è stata valutata applicando un modello matematico alle curve di glucosio e di C-peptide derivanti da prelievi eseguiti durante OGTT, ed è differenziabile in due componenti: prima fase di secrezione insulinica o controllo derivativo, rappresentato dalla quantità di insulina secreta in risposta all’incremento unitario della concentrazione di glucosio, e la seconda fase di secrezione o controllo proporzionale, rappresentato come la velocità di secrezione insulinica a concentrazioni crescenti di glucosio (5.5, 8.0, 11.0, 15.0 and 20.0 mM). La misura della sensibilità insulinica deriva dalla quantità di glucosio infuso che viene metabolizzato negli ultimi 60 minuti del clamp euglicemica, tale valore è detto M. Sono stati genotipizzati i seguenti SNP, già visti essere associati allo sviluppo di T2DM: rs7901695 (TCF7L2), rs7903146 (TCF7L2), rs11196205 (TCF7L2), rs12255372 (TCF7L2), rs679931 (CACNA1E), rs1801282 (PPARG), rs1044498 (ENPP1), rs10946398 (CDKAL1), rs1111875 (HHEX/IDE) rs10010131 (WFS1), rs4430796 (TCF2), rs4402960 (IGF2BP2). Risultati. TCF7L2. Gli alleli di rischio di 3 su 4 polimorfismi di TCF7L2 (rs7901695, rs7903146, rs11196205) sono associati a più alti valori plasmatici di glucosio a digiuno (p<0.001, p<0.03 e p<0.01 rispettivamente). Gli allele di rischio dei primi due SNP (rs7901695 e rs7903146) sono associati ad un aumento del controllo proporzionale della funzione beta cellulare (p<0.02 e p<0.03 rispettivamente). Tramite l’analisi degli aplotipi sono stati individuati 4 aplotipi rappresentati nella popolazione in esame e due di questi (haplo4, frequenza: 0.038 e haplo9, frequenza: 0.086) hanno un forte impatto sulla funzione beta-cellulare. Altre varianti geniche. Nessuno dei rimanenti 8 polimorfismi (rs679931, rs1801282, rs1044498, rs10946398, rs1111875, rs10010131, rs4430796, rs4402960) ha mostrato associazione indipendente con alterazioni della funzione beta-cellulare o della sensibilità insulinica. Abbiamo calcolato uno score genetico di queste varianti sommando il numero di alleli di rischio presenti in ogni paziente (escludendo TCF7L2). I pazienti sono stati divisi in tre gruppi: portatori di un numero di alleli di rischio ≤ 6 (gruppo A, n=76), pazienti con un numero di alleli di rischio compresa tra 7 e 9 (gruppo B, n=226) e soggetti con un numero di alleli di rischio ≥ 10 (gruppo C, n=69). Il controllo proporzionale della funzione beta cellulare risultava alterato in modo statisticamente significativo (p=0.05) nel gruppo C rispetto agli altri due gruppi. Maggiore è il numero di alleli di rischio associato a T2DM, peggiore è la funzione beta-cellulare. Conclusioni. Questi dati mostrano come diverse varianti geniche giocano un ruolo significativo nel determinare il fenotipo patofisiologico dei pazienti con T2DM neo-diagnosticato, influenzando soprattutto la funzione beta-cellulare. Perciò, la valutazione dei genotipi di rischio per il T2DM potrebbe tornare utile per scopi diagnostici, prognostici e terapeutici in pazienti con T2DM neodiagnosticato.
Background. Genome wide association studies (GWAS) have played a primary role in demonstrating that genetic variation in a number of loci, as assessed by single nucleotide polymorphisms (SNPs), affects the risk of type 2 diabetes mellitus (T2DM). Among these, rs7903146, an intronic variant of the TCF7L2 (Transcription Factor 7 Like 2) gene, is possibly the strongest known genetic risk factor for T2DM (O.R.=1.37). Each risk variant, however, per se contributes quantitatively little to the overall risk and is often of questionable biological significance in affecting the determinants of glucose regulation. Aim(s). To elucidate the effects of several T2DM risk genetic loci on clinical and pathophysiological (beta-cell function and insulin sensitivity) phenotypes of patients with newly diagnosed T2DM. Methods. We studied 464 patients of Italian ancestry with newly diagnosed, GAD-antibody negative, type 2 diabetes mellitus. Standard clinical phenotyping was carried out by classical methods. Beta-cell function and insulin sensitivity were assessed by mathematical modeling of glucose and C-peptide curves during a 240’ frequently sampled OGTT and by euglycemic insulin clamp, respectively. Beta-cell function is described as the sum of two components: i. first phase of insulin secretion or derivative control (DC), presented as the pulse secretory response to a unit rate of change in glucose concentration; ii. second phase of insulin secretion or proportional control (PC), presented as the insulin secretion rate at glucose concentrations of 5.5, 8.0, 11.0, 15.0 and 20.0 mM, respectively. Insulin sensitivity is presented as the amount of glucose infused which is metabolized in the last 60’ of the euglycemic clamp (M value). The following SNPs (related gene in brackets), already known to be risk loci of T2DM, were genotyped: rs7901695 (TCF7L2), rs7903146 (TCF7L2), rs11196205 (TCF7L2), rs12255372 (TCF7L2), rs679931 (CACNA1E), rs1801282 (PPARG), rs1044498 (ENPP1), rs10946398 (CDKAL1), rs1111875 (HHEX/IDE) rs10010131 (WFS1), rs4430796 (TCF2), rs4402960 (IGF2BP2). Results. TCF7L2. The risk alleles of 3 (rs7901695, rs7903146, rs11196205) out of 4 TCF7L2 SNPs were associated with higher fasting plasma glucose (p<0.01, p<0.03 and p<0.01 respectively). The risk alleles of the first two SNPs (rs7901695, rs7903146) were associated to a decrease in the proportional control of beta-cell function (p<0.02 and p<0.03 respectively). Four TCF7L2 haplotypes were detected, two of which (haplo4, frequency: 0.038; and haplo9, frequency: 0.086) had a strong impact on beta-cell function. Haplo4 was associated with the lowest proportional control of beta-cell function while haplo9 showed the highest. Other genetic variants. None of the 8 remaining SNPs (rs679931, rs1801282, rs1044498, rs10946398, rs1111875, rs10010131, rs4430796, rs4402960) showed any significant independent association with insulin sensitivity or beta-cell function. We computed a genetic risk score of this variants, by summing the number of the T2DM risk alleles present in each patient (excluding TCF7L2). The patients were divided into three groups: 6 or less risk alleles (group A, n=76), 7-9 risk alleles (group B, n=226), 10 or more risk alleles (group C, n=69). The porportional control of beta-cell function was significantly impaired (P=0.05) in group C than in the other two groups, i.e. the higher the number of T2DM risk variants the lower beta cell function. Conclusions. These data show that several genetic variants play a significant role in determining the pathophysiological phenotype of patients with newly diagnosed type 2 diabetes, with most of the influence exerted on beta-cell function. Thus, assessment of T2DM risk genotype may turn to be useful for diagnostic, prognostic and therapeutic purposes in patients with newly diagnosed T2DM.

Type 2 diabetes is a chronic disease whose incidence has increased with more than 200% during the past 20 years. The increasing number of type 2 diabetes patients could result in more patients suffering from lower quality of life and life threatening complications. Furthermore, the growing need of care will increase the load on healthcare. To counteract this effect, digital tools could be used to put more care responsibility on the patient.  The aim of this project was to find and implement the relevant features for a digital type 2 diabetes tool for newly diagnosed patients. The final goal was to encourage self-care, reduce anxiety and thus improve quality of life, while decreasing the risk of complications. The research process of this project consisted of five phases: literature study (to find relevant features and their clinical evidence), interviews (to find the desires of patients and practitioners), data analysis (to prioritise features), development of the features and evaluation of the tool.  The results showed that important features were documentation of blood glucose measurements, patient education, data transfer, communication and care plan overview, but even more importantwas the possibility to individualise the tool for different patients. The evaluation indicated that a clear care plan overview that was easy to understand could help the patient prioritise care activities. Furthermore, patients could be encouraged by reminders, seeing improvements and having continuous communication with healthcare. It was found that for positive clinical outcomes, high usability is essential. To reach patient acceptance the tool must be relevant and easy to use. It must also give valuable output, such as decision support for self-care or new knowledge. To reach practitioner acceptance the tool should be based on evidence based methods and integrate well with existing systems.  Finally it was concluded that the knowledge and technology needed to build a successful tool is already present, they only need to be put together and formulated in a way which is understandable and useful for both patients, caregivers and developers.
Diabetes typ 2 är en kronisk sjukdom vars incidens har ökat med mer än 200% de senaste 20 åren. Det stigande antalet patienter med diabetes typ 2 kan leda till att fler patienter blir lidande av lägre livskvalitet och livshotande komplikationer. Dessutom ökar det stigande vårdbehovet belastningen på vården. För att motverka denna effekt kan digitala verktyg utvecklas så att mer ansvar kan läggas på patienten. Syftet med detta projekt var att hitta och implementera relevanta funktioner för ett digitalt verktyg för nydiagnostiserade patienter med diabetes typ 2. Målet var att uppmuntra egenvård, minska oro och därmed öka livskvaliteten samt minska risken för komplikationer. Projektets forskningsprocess bestod av fem faser: litteraturstudie (finna relevanta funktioner och deras evidens), intervjuer (kartlägga krav från patienter och vårdgivare), dataanalys (prioritera funktioner), utveckling av funktioner i HOPE platform och slutligen utvärdering av verktyget i HOPE platform. Resultaten visade att dokumentation av blodglukosmätningar, patientutbildning, dataöverföring, kommunikation och vårdplansöversikt var viktiga funktioner, men ännu viktigare var möjligheten att individanpassa verktyget för varje patient. Utvärderingen indikerade att en tydlig vårdplansöversikt som är enkel att förstå hjälper patienten att prioritera de viktigaste vårdaktiviteterna. Vidare kan patienter motiveras av påminnelser, att se förbättring och att ha kontinuerlig kontakt med vården. Det konstaterades att hög användbarhet är nödvändig för att uppnå positiva kliniska effekter. För att nå acceptans hos patienterna måste verktyget vara relevant, enkelt att använda och ge något värdefull tillbaka, så som beslutsstöd för egenvård eller ny kunskap. För att nå acceptans hos vårdgivarna bör verktyget baseras på evidensbaserade metoder och vara kompatibelt med nuvarande system. Slutligen drogs slutsatsen att kunskapen och tekniken för att skapa ett lyckat verktyg redan finns, men att kraven måste sammanställas och formuleras på ett sätt som är förståeligt och användbart för både patienter, vårdgivare och utvecklare.

Published research on diabetes in Ghana is quite limited and relates mainly to incidence and prevalence of the disease with little research on the patients experiences of coping with the diabetes. It is estimated that diabetes affects 6.3% of the Ghanaian population with type 2 diabetes accounting for 90-95% of all cases of diabetes. In Ghana, individuals diagnosed with type 2 diabetes mellitus are confronted with difficulties including the high cost of treatment of the condition, stigmatization, and interruptions to normal physiological processes. In addition, the patients experience, limited clinic accessibility, inadequate drug availability, inadequate numbers of trained staff, as well as limited availability of equipment needed for adequate care of the condition. The review of literature for this current thesis also showed that none of the studies on coping were undertaken in Ghana, but were conducted in the western world where socio-cultural factors are quite diverse from the Ghanaian situation. In the light of the challenges facing diabetic patients as well as the gap observed in literature, the study set out to explore the coping strategies of patients with type 2 diabetes mellitus at a hospital in Ghana. A hermeneutic phenomenological approach to qualitative research was utilized. Twenty seven (27) in-depth interviews carried out with newly diagnosed patients with type 2 diabetes, between August and October 2009 at a hospital in Ghana. Interviews were conducted in the local Ghanaian Twi language and English. Participants who could not speak English were interviewed in Twi language and later translated into English by the researcher. Data analysis used Creswell (1998) approach to qualitative data analysis, which provided a rich description of the essential structures of the phenomenon under study. The study identified patients’ perceptions as to the causes of diabetes mellitus, the social meanings attributed to diabetes (with particular attention paid to the language by Ghanaian people to describe disease condition), and subsequently reactions and resolutions to diagnosis. Patients discussed treatment options, while at the same time remaining hopeful of finding a cure. All patients had a firm spiritual belief system that underpinned their understanding of the causation and treatment of their illness. This combined with various degrees of understanding and acceptance of western explanations of illness influenced the coping strategies employed by patients, which variously reported as positive, negative, and alternative strategies. The study establishes a platform upon which health providers can develop educational programmes for diabetic patients in Ghana, which will address misconceptions about diabetes mellitus in Ghana and the importance of programmes of care, which take account of and build upon the cultural context of ‘being Ghanaian’. Diabetes, at least for Ghanaian patients is more than a biomedical disease. In this sense a biomedical framework in and of itself will not enable healthcare providers to effectively manage this chronic disease in the Ghanaian population, but through the inclusion of an understanding of their spiritual beliefs, healthcare providers can understand the realities of what it is like for Ghanaian diabetes patients to live with diabetes. It is argued that a stronger collaboration and integration between traditional healthcare systems and orthodox healthcare systems will provide the optimum opportunity to maximize patient care in Ghana. Future research should concentrate on better understanding how lay knowledge and health related attitudes, beliefs and behaviours are associated with diabetes in Ghana.

Bakgrund: Diabetes typ 2 utgör den vanligaste diabetesformen, och cirka 4 % av Sveriges befolkning uppskattades ha diabetes 2010, varav nästan 90 % av dessa utgjordes av diabetes typ 2. Sjuksköterskan har en viktig roll i att stödja och vägleda patienten utifrån dennes upplevelser och behov. Syfte: Att beskriva hur vuxna patienter upplever att diagnostiseras med diabetes typ 2. Metod: Denna studie är en litteraturstudie baserad på tidigare forskning kring diabetes typ 2, och kommer att fokusera på fenomen relaterat till patienters upplevelser av att få en diagnos. Författarna identifierade sex teman: Upplevelser och känslomässiga reaktioner vid diagnos, Information och kunskap, Lära sig leva med diabetes, Att förneka sin sjukdom, Eget ansvar och egenvård samt Syn på framtiden. Teoretisk referensram: Som teoretiskreferensram valdes  Afaf Meleis' Transitionsteori som bygger på tanken om att människor går igenom transitioner i livet av olika art. Resultat: Resultaten visade att deltagarna upplevde att få en diagnos som diabetes typ 2 på olika sätt beroende på hur deras liv sett ut tiden innan diagnos. Det framkom också att kunskapen kring diabetes varierade och att deltagarna hade olika behov av information och stöd vid tillfälle för diagnos. Diskussion: Att få en diagnos som diabetes typ 2 kan upplevas olika och vi har sett att det finns vissa faktorer som kan påverka upplevelsen. Faktorer som vi menar kan ha en inverkan är: den information och det stöd som ges vid diagnos, samt vilket bagage och vilken förförståelse personen i fråga har sedan tidigare.
Background: Type 2 Diabetes is the most common form of diabetes, and approximately 4 % of Sweden's population was estimated to have diabetes in 2010, and almost 90 % of these consisted of type 2 diabetes. The nurse has an important role in supporting and guiding the patient based on his experiences and needs. Aim: To describe how adult patients experience of being diagnosed with diabetes type two. Method: This study is a literature review based on previous research on type 2 diabetes, and the focus will be on the phenomenon related to patient experiences of being diagnosed with type 2 diabetes. The authors identified six themes: Experiences and emotional reactions at diagnosis, Information and knowledge, Learning to live with diabetes, To deny their illness, Personal responsibility and self-care and views of the future. Theoretical framework: The theoretical framework that was chosen for this study was Afaf Meleis' Transition Theory, which is based on the idea that people go through different transitions in life. Results: The results showed that patients experienced diagnosis of type 2 diabetes in different ways, depending on what their life looked like at the time before diagnosis. Findings also demonstrated that knowledge about diabetes varied among participants, and that they had different needs for information and support at the time of diagnosis. Discussion: To receive a diagnosis like type 2 diabetes, can be experienced in different ways, and we have seen that certain factors can have an impact on the experience. These factors that we have identified are: information and support at the time of diagnosis, and the baggage and pre-understanding the person have before diagnosis.

Bakgrund: I dagens samhälle flödar information från många olika håll. Kunskap förmedlas till patienter och anhöriga av olika professioner utan samordning, vilket kan leda till missförstånd. För patienter med diabetes typ 2 är det viktigt att få information som kan förstås och som är relevant för deras sjukdom. Genom patientutbildning kan patienten sedan bedriva egenvård och ta kontroll över sjukdomen. Syfte: Syftet med studien var att se hur patienter med nydiagnostiserad typ 2 diabetes förstår egenvård efter besök hos diabetessköterskan. Metod: En empirisk, kvalitativ intervjustudie genomfördes och innehållet analyserades med kvalitativ innehållsanalys inspirerad av Graneheim och Lundman. Resultat: Det framkom under intervjuerna att ungefär hälften av deltagarna förväntade sig att drabbas av diabetes, då det fanns i släkten. Diabetes var naturligt att få vid en viss ålder, med eller utan egenvård. De flesta hade gjort förändring av kostvanor och rökning under de första månaderna efter diagnosen och fått bekräftat att egenvården gjort nytta. Många kände oro inför att inte orka fortsätta med de förändringar, men var ändå inte oroliga för framtiden. Andra hade fortsatt stor tillförsikt och visste att resultatet berodde på dem själv. Slutsats: Med eller utan tidig egenvård hade sjukdomen kommit ändå. Den första tiden efter diagnosen genomfördes förändringar och egenvården kändes viktig. När sedan känslan av att ”må bra” återkom, dalade motivationen. Med täta besök hos diabetessköterskan motiverades patienterna att fortsätta.

Background: In today's society, information flowing from many different directions. Knowledge communicated to patients and families of different professions, without coordination, which can lead to misunderstandings. For patients with diabetes type 2, it is important to get information that is understandable and relevant to their illness. Through patient education, the patient may then engage in self-care and take control of the disease. Aim: The purpose of this study was to see how patients with newly diagnosed type 2 diabetes understand self-care after visiting the nurse. Method: An empirical, qualitative interviews were carried out and contents were analyzed using qualitative content analysis inspired by Granheim and Lundman. Results: It emerged during the interviews that about half of the participants expected to suffer from diabetes, when there was a family history. Diabetes was natural to get at a certain age, with or without self-care. Most patients had made changes in diet and smoking during the first months after being diagnosed and confirmed that self-care was useful. Many felt concerned about not being able to continue with the changes, but was not worried about the future. Others had continued very confident and knew that the outcome depended on themselfs. Conclusion: With or without early self-care the disease would had come anyway. The first time after beeing diagnosed, change and self-care feelt important. When the sense of "feel good" reappeared, the motivation faded. With frequent visits to the nurse, the patients were motivated to continue.

The Early ACTID Study is a randomised controlled trial of diet plus exercise vs. diet alone and usual care in adults with type 2 diabetes, who were recruited five to eight months after diagnosis. The purpose of this study was 1) develop intervention materials to facilitate change in physical activity levels, 2) describe objectively measured habitual physical activity, 3) examine change in physical activity over six months, 4) explore the use of pedometers and diaries to monitor daily physical activity over a six-month period, 5) describe CRF levels, and 6) explore the independent and interactive cross-sectional associations of physical activity and CRF and HbA1c and the clustering of cardiovascular risk factors (i.e., metabolic syndrome) among adults with recently diagnosed T2D recruited to the Early ACTID Study. 340 Participants (207 men, and 133 women), aged 59.3�10.38 years, were recruited to the study. Conclusions: Levels of physical activity and CRF were low in participants recruited to the Early ACTID Study. Although physical activity and CRF were not associated with glycaemic control, higher levels were associated with a lower prevalence of the metabolic syndrome. The protective effect of physical activity and CRF was stronger in women than men. The use of pedometers and diaries appears to be acceptable to adults with T2D who are attempting to increase their physical activity.

Background/clinical context: Type 2 diabetes (T2DM) is associated with an increased risk of adverse outcomes. Data routinely recorded in general practice electronic patient records could be used to develop risk prediction models to identify those at higher risk and target preventative treatment. Objective: To develop models to predict the 5-year risk of coronary heart disease (CHD), stroke, chronic kidney disease (CKD), and all-cause mortality following a diagnosis of T2DM. Methods: Newly diagnosed T2DM patients registered at a practice contributing data to a large UK general practice database were included in the analyses. The models included clinical predictors routinely recorded following diabetes diagnosis plus cardiovascular preventative treatments. Results: 20041 patients diagnosed with T2DM were included. The proportion of variation explained by each model (R2) was: CHD 0.09; stroke 0.35; CKD 0.34; and mortality 0.58. Hazard ratios for modifiable risks in the mortality model were: current smoking 1.65; blood pressure (high/treated) 1.07; and glycaemic control (HbA1C/%) 1.09 (p<0.01 apart from BP). Conclusion: The models were predictive, particularly for mortality, and suggest that older, male, smokers, those with poor blood pressure and glycaemic control and those with cardiovascular co-morbidity are at highest risk and should be targeted at the point of diagnosis.

碩士
國立陽明大學
醫務管理研究所
105
Abstract Background: Diabetes is an increasing global health problem. For maintaining optimal glycemic level of patients with Type 2 diabetes(T2D), various classes of glucose-lowing drugs are used. The mechanisms of each class is different from each other. Objective: The purpose of the study was to analyze the first anti-diabetic drugs medicinal for newly diagnosed type 2 diabetes patients and their characteristics including age, sex, and hospital level. Methods: Data of T2D in the study were from the Taiwan National Health Insurance Database in 2010. The main classes of glucose-lowing drugs included acarbose, metformin, sulfonylureas, dipeptidyl peptidase-4 inhibitors, thiazolidinediones, and meglitinide. Results: Of the 3830 patients analyzed, metformin was prescribed 59%, followed by 30%, sulfonylurea, 5% thiazolidinedione, 3% acarbose, 2% Dipeptidyl peptidase-4 inhibitors,and 2% meglitinide, as their first monotherapy. Metformin was mainly prescribed by endocrinologists and sulfonylurea was first considered by family physicians. Over half of the patients (57%) receiving their prescriptions from physicians with the specialty of general medicine, 24% family medicine, and 19% from endocrinology. Conclusions: The results of this study provide insight from national prospective regarding medications and the treatment characteristics to better understand the drug pattern for the newly diagnosed T2D patients. Key words: type 2 diabetes mellitus, drug pattern, anti-diabetic drug

碩士
國立中山大學
醫務管理研究所
99
Objective: To recognize the difference of patient care offered by primary care family physician, internist and generalist, according to the incidence rate of the acute complications, time to event interval of the chronic complications and the cost of OPD, admission and emergency care. Method: The first diagnosed diabetes patients were extracted from the National Health Insurance database, utilizing data from 2001 to 2007 to fit the criteria. Patients with catastrophic illness and who attended to the primary care clinic less than 20% of total OPD visits were excluded. The incidence rate of DM acute complications such as hypoglycemia, NKHS and DKA, and the time to event interval of DM chronic complications such as CAD, stroke, DM nephropathy, DM retinopathy, polyneuropathy and DM peripheral artery disease were investigated. Furthermore, the cost of OPD visit, emergency care and hospital admission was also evaluated. Result: The patients cared by primary care family physician tended to get hypoglycemia more frequently, but less likely to get hyperglycemic complications including both DKA and NKHS.The family physician did not recognize the large vessel complications well but can effectively control the diabetic neuropathy and diabetic nephropathy. Compare to those cared by internist, the patients cared by family physician have the lower expense on diabetic related OPD visit, but a little higher on emergency and admission. Totally, the patients cared by family physician have the lowest cost compared to internist and generalist, but without significant difference. Conclusion: The cost of OPD visit was significantly lower in patient cared by primary care family physician compared to internist without sacrifice the quality of care. Further study was necessary due to the limitation of the application of secondary database.