2000, Number 4
Integrated detection as instrument for linking primary prevention, early treatment and epidemiological surveillance in diabetes and hypertension
Velázquez MÓ, Lara EA, Martínez MMY, Márquez FF
Full text
Language: Spanish
References: 9
Page: 113-119
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ABSTRACT
Introduction: Diabetes and hypertension are chronic degenerative diseases with prolonged periods of latency. They represent a serious financial problem for health-care services and a major challenge for society. The prevalence of diabetes in the population between the ages of 20 and 69 is 8.2% according to the National Survey of Chronic Diseases (ENEC93) and in 1999 there were an estimated 4.3 million diabetics, 29.2% of whom (about 1.25 million) have not been diagnosed; 70.8% (over 3 million) know they have the disease but just 11% (473,000) visit government health services (SSA) regularly for treatment. Hypertension is an important risk factor in ischemic heart disease, cerebrovascular disease and nephropathies. Mortality from these diseases has increased in recent decades and they currently rank among the leading causes of death. The elderly are a high risk group, which means that an intensive campaign for the detection, diagnosis, treatment and control of these diseases is required to prevent or delay mortality. Methodology: We performed a descriptive study, involving the integrated detection of diabetes and hypertension (Could you have diabetes and not know it?) in 6,186 individuals over the age of 25, belonging to both sexes, who attended the SSA’s health units or other health-care facilities. The participating states were Guanajuato, the state of Mexico, Jalisco and San Luis Potosi and the study lasted for one year. The detection process involved two stages: first a duly validated questionnaire on risk factors was administered, the tools for detection were the questionnaire “Could you have diabetes and not know it?, the capillary glycemia tests read with a blood glucose monitor and confirmation at diabetes with the blood glucose test read in the laboratory. Test for high blood pressure were performed on the population 25 years of age and over, using an average of two random measurements. The diagnosis of patients with results over 139/89 was confirmed by taking an average of two measurements separated by five or more minutes, on two subsequent occasions. If any of the figures fell between the two categories, the upper figure was used, and patients were classified in stages 1, 2 or 3. Healthy life styles and comprehensive treatment were recommended. Statistical analysis: Simple frequencies were obtained. Results: 6,168 subjects from four states-state of Mexico with 18.1% (1,122), Guanajuato with 8.1% (501), Jalisco with 8% (495) and San Luis Potosi with 65.8% (4,068) participated in the study on integrated detection of diabetes and hypertension. Eighty percent of the subjects were tested at a social security facility (SSA) (4,949), 12.6% at IMSS (779), 6.9% at ISSSTE (427) and 0.5% (31) at other institutions. The predominant gender was female (73.4% (4,541), with males accounting for 26.6% (1,645). The prevailing age group was under 49 (72%) (4,454 individuals), the 50 to 64 group accounted for 20.5% (1,268) and the group 65 and over for 7.5% (464 individuals). 2,648 capillary glycemia tests were performed, 475 people were referred to self-help groups, and 323 blood glycemia tests were performed. For every 100 questionnaires administered 40 required random capillary glycemia tests. For every 64 questionnaires administered, one case of diabetes presented and 28 capillary glycemia tests were performed for every case of diabetes. Blood pressure was taken in 6,456 cases plus 270 confirmation measurements. One case of hypertension was found in every 50 tests. In the initial distribution of hypertension the largest percentage (83%) had optimum or normal pressure; high-normal pressure was found in 9.2%. Suspect cases in stages 1, 2 and 3 amounted to 7.9%, who were referred for confirmation. Just 55% of referrals showed up for the test and 46% of them were diagnosed with high blood pressure, or 2% of all the individuals surveyed. The direct unit cost for both tests was Mex $2.70 (lancet, reactive strip, blood pressure tests and questionnaires, May 1999), the cost of detection for each case of diabetes or hypertension was Mex $80.45. Conclusions: The method of integrated detection of diabetes and hypertension used in this study resulted in a savings of resources, by using a scale of duly validated risk factors. A large percentage of the population in this study belonged to high-risk groups for diabetes (sedentary, smokers, alcoholism, obesity, family history, etc.) which is consistent with other studies. This suggests that there should be more guidance and monitoring of the individuals tested, to encourage them to go for diagnostic confirmation. Integrated detection is an efficient intervention for identification, making early treatment possible and preventing the development of complications. It also increases low-cost detection, examines risk factors and is useful for promoting healthy life styles. The advantages of this detection method are clear and in future it will bring greater benefits to society.REFERENCES