Jiménez-Cruz A, Bacardí-Gascon M, Peña-Valdovinos A, Leyva-Pacheco R

Language: Spanish
References: 19
Page: 236-243
PDF size: 36.93 Kb.

ABSTRACT

Objective. The purpose of this study was to assess health care practices and metabolic control of type II diabetics in primary and secondary care settings, attended by family practitioners, orby internal medicine and endocrinology specialists in México. Material and methods. A cross-sectional survey was performed in Tijuana, México, with data obtained from four primary care clinics and a secondary care clinic of the Instituto Mexicano del Seguro Social. Every clinical chart with a special diabetes form from August 18th through September 18th, 1995 was reviewed. Results. The incidence of recording fasting blood glucose was higher among the internal medicine and endocrinology specialists, whereas the incidence of recording weight was found to be higher by the family practitioners (p ‹ 0.05). Age and duration of diabetes were recorded more often by the internal medicine and endocrinology specialists. The use of insulin treatment was also found higher among internal medicine and endocrinology specialists. There were no statistical differences found between groups for mean fasting blood glucose, total cholesterol, body mass index, nor for different cutoff points used for fasting blood glucose and body mass index. The internal medicine and endocrinology specialists had recorded hypercholesterolemia more often than the family practitioners (p ‹ 0.05). Discusion. It was shown that there are differences in recording measurements and clinical outcomes between the two groups. However, the findings were not adequate with recommended criteria, or with the advanced diabetes training of the internal medicine and endocrinology specialists. The results suggest that specific diabetes guidelines with surveillance systems should be developed, according to budget availability for local sites.

REFERENCES

1. DCCT Research Group. The effect of intensive treatment of diabetes on the development and progression of longterm complications in insulin-dependent diabetes mellitus: the diabetes control and complications trial. N Engl Med 1993; 329: 977-86.

2. Nathan DM. Inferences and implications. Do results from the diabetes control and complications trial apply in NIDDM? Diabetes Care 1995; 18: 251-7.

3. Klimt CR, Knatterud GL, Meinert CL, Prout TE. The University Group Diabetes Program: a study of the effect of hypoglycemic agents on vascular complications in patients with adult-onset diabetes. I. Design, methods and baseline charcteristics. II. Mortality results. Diabetes 1970; 19 (Suppl. 2): 747-830.

4. Hadden DR, Blair ALT, Wilson EA, et al. Natural history of diabetes presenting age 40-69 years: a prospective study of the influence of intensive dietary therapy. Q J Med 1986; 230:579-588.

5. Wang PH, Lau J, Chalmers TC. Meta-analysis of effects of intensive blood-glucose control on late complications of type I diabetes. Lancet 1993; 341: 1306-9.

6. DCCT Research Group. Effect of intensive diabetes management on macrovascular events and risk factors in the diabetes control and complications trial. Am J Card 1995; 75: 894-903.

7. Peña-Valdovino A, Jiménez-Cruz A, Leyva-Pacheco R, Bacardí-Gascón M. Poor metabolic control in diabetic patients at the primary care level. Diabetes Res Clin Pract 1997; 37:179-84.

8. González-Villalpando CG, Stern MP, Arredondo-Pérez B, Martínez-Díaz S. The level of metabolic control in low income Mexico City diabetics. The Mexico City Diabetes Study. Arch Med Res 1994; 25: 387-92.

9. American Diabetes Association. Standards of medical care for patients with diabetes mellitus. Diabetes Care 1994; 17:616-23.

10. Peters AL, Legorreta AP, Ossorio RC, Davidson MB. Quality of outpatient care provided to diabetic patients. Diabetes Care 1996;19:601-6.

11. Harris MI, Cowie CC, Howie LJ. Self monitoring of blood glucose by adults with diabetes in the United States population. Diabetes Care 1993; 16:1116-23.

12. Eriksson J, Forsen B, Haggblom M, Teppo AM, Groop L. Clinical and metabolic characteristics of type 1 and type 2 diabetes: an epidemiological study from the Narpes Community in Western Finland. Diabetic Med 1992; 9:654-60.

13. Abdella NA, Khogali MM, Salman AD, Ghuneimi SA, Bajaj JS. Pattern of non-insulin dependent diabetes mellitus in Kuwait. Diabetes Res Clin Pract 1995; 29:129-36.

14. Hiss RG, Anderson RM, Hess GE, Stepien CJ, Davis WK.Community diabetes care: a 10-year perspective. Diabetes Care 1994;17:1124-34.

15. Greenfield S,Nelson EC, Zubkoff M, Manning W, Rogers W, Kravitz RL, et al. Variations in resource utilization among medical specialties and systems of care. Results from the Medical Outcomes Study. JAMA 1992; 267:1624-30.

16. Greenfield S, Rogers W, Mangotich M, Carney MF, Tarlov AR. Outcomes of patients with hypertension and non-insulin-dependent diabetes mellitus treated by different systems ans specialities. Results from the Medical Outcomes Study. JAMA 1995; 274:1436-44.

17. Fihn SD. Physician speciality, systems of health care, and patient outcomes. JAMA 1995; 274:1503-08.

18. Weiner JP, Parente ST, Garnick DW, Fowles J, Lawthers AG, Palmer H. Variation in office-based quality: A claims-based profile of care provided to medicare patients with diabetes. JAMA 1995; 273:1503-8.

19. Franz MJ, Splett PL, Monk A, Barry B, McClain K, Weaver T, et al. Cost-effectiveness of medical nutrition therapy provided by dietitians for persons with non-insulin dependent diabetes mellitus. J Am Diet Assoc 1995; 95:1018-24.