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ISSN 0016-3813 (Print)

2009, Number 6

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Gac Med Mex 2009; 145 (6)

Prevalencia de control glucémico y factores relacionados en pacientes con diabetes mellitus tipo 2 del Hospital Universitario de San Ignacio, Bogotá, Colombia

Alba LH, Bastidas C, Vivas JM, Gil G

Language: Spanish
References: 51
Page: 469-474
PDF size: 89.22 Kb.


ABSTRACT

Introduction: Diabetes mellitus is a common disorder worldwide that produces significant morbi-mortality that could be reduced with proper glycemic control.
Objective: Estimate the prevalence of glycemic control in type-2 diabetic patients and explore its association with personal, clinical and familial factors.
Materials and methods: We conducted a cross-sectional study with 150 type-2 diabetic patients from a chronic diseases program at the Hospital Universitario San Ignacio in Bogota. Clinical and family (type and lifecycle) information was obtained. Adherence to treatment and family function (family-APGAR) were assessed. The prevalence of glycemic control (HbA1C ‹7%) was estimated and its association with determinant factors was calculated using crude and adjusted odds ratios (OR’s).
Results: The prevalence of glycemic control was 49% (HbA1C ‹7%) and 63% when we included a different goal for patients over 71 years or with a disease lasting longer than 11 years (HbA1c 7-7.9%). Age, family function, type and adherence to treatment showed significant differences between controlled and uncontrolled patients (p ‹0.04). Only family function (OR 1.3 and 7.0 for mild dysfunction and moderate/severe dysfunction respectively) and type of treatment (OR 7.2 for oral therapy and 17.8 for any therapy including insulin) showed an association with glycemic control.
Conclusions: Family function and treatment type are relevant factors for glycemic control. A comprehensive approach for diabetes mellitus type-2 is essential to plan effective preventive and therapeutic interventions.


REFERENCES

  1. Goroll AH, Mulley AG, editors. Screening for diabetes mellitus. En: Goroll AH, Mulley AG, editors. Primary care medicine: office evaluation and management of the adult patient. 4th edition. Philadelphia: Lippincott Williams & Wilkins; 2000. pp. 598-601.

  2. Adeghate E, Schattener P, Dunn E. An update on the etiology and epidemiology of diabetes mellitus. Ann N Y Acad Sci 2006;1084:1-29.

  3. Federación Diabetológica Colombiana. Guías de atención en diabetes dentro del Sistema General de Seguridad Social en Salud. Mosquera, Cundinamarca: Ministerio de Protección Social, República de Colombia; 2000.

  4. Asociación Latinoamericana de Diabetes. Guías ALAD de diagnóstico control y tratamiento de la diabetes mellitus tipo 2. Rev Asoc Latinoam Diabetes 2006;14:78.

  5. Ministerio de Protección Social. Estudio nacional de factores de riesgo de enfermedades crónicas ENFREC II. Colombia: Ministerio de Protección Social; 1999.

  6. Molina I, Orrego A, Londoño F, Moreno E. Diabetes mellitus y obesidad. Guías de práctica clínica basadas en la evidencia. Colombia: Instituto de Seguros Sociales, Asociación Colombiana de Facultades de Medicina; 1999.

  7. Alayón AN, Alvear C. Prevalencia de desórdenes del metabolismo de los glúcidos y perfil del diabético en Cartagena de Indias (Colombia), 2005. Salud Uninorte 2006;22:20-28.

  8. Montoya C. Retinopatía diabética y diabetes mellitus. Franja Ocular 2001;2:11-14.

  9. Massi-Benedetti M. The cost of diabetes type II in Europe. The CODE-2 Study. Diabetologia 2002;45:S1-4.

  10. King H, Aubert R, Herman W. Global burden of diabetes 1995-2005. Diabetes Care 1998;21:1414-1431.

  11. Jönsson B. Reveling the cost of type II diabetes in Europe. Diabetologia 2002;45:S5-S12.

  12. Ray KK, Seshasai SR, Wijesuriya S, Sivakumaran R, Nethercott S, Preiss D, et al. Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials. Lancet 2009;373:1765-1772.

  13. American Diabetes Association. Standards of medical care-2009. Diabetes Care 2009;32 Suppl 1:S13-S61.

  14. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of longterm complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329:977-986.

  15. Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 321:405-412.

  16. Worrall G. Results of the DCCT trial: implications for managing our patients with diabetes. Can Fam Phys 1994;40:1955-1965.

  17. Montori VM, Fernández M. Glycemic control in type 2 diabetes: time for an evidence-based about-face? Ann Intern Med 2009;150:803-808.

  18. Cohen A, Horton ES. Progress in the treatment of diabetes type 2: new pharmacologic approaches to improve glycemic control. Curr Med Res Opin 2007;23:905-917.

  19. Gulve EA. Exercise and glycemic control in diabetes: benefits, challenges, and adjustments to pharmacotherapy. Phys Ther 2008;88:1297-1321.

  20. Trief PM, Sandberg J. Describing support. A qualitative study of couples living with diabetes. Fam Syst Health 2003:21:57-67.

  21. Thompson SJ, Auslander WF, White NH. Influence of family structure on health among youths with diabetes. Health Soc Work 2001;26:7-14.

  22. Anderson BJ. Miller JP, Auslander WF, Santiago JV. Family characteristics of diabetic adolescents: relationship to metabolic control. Diabetes Care 1981;4:586-594.

  23. Jacobson AM, Hauser ST, Lavori P, Willett JB, Cole CF, Wolfsdorf JI, Dumont RH, WertliebD. Family environment an glycemic control: a four-year prospective study of children and adolescents with insulin-dependent diabetes mellitus. Psychosom Med 1994;56:401-409.

  24. Profamilia, Instituto Colombiano de Bienestar Familiar, United States Agency International Development, Ministerio de Protección Social, United Nations Population Fundation. Encuesta nacional de demografía y salud. Colombia: Profamilia, Instituto Colombiano de Bienestar Familiar, United States Agency International Development, Ministerio de Protección Social, United Nations Population Fundation; 2005.

  25. Arias L, Herrera J. El Apgar familiar en el cuidado primario. Colomb Med 1994;25:26-28.

  26. Arias L, Montero JT, Castellanos J. El ciclo vital familiar. Interacción humana, integralidad y ciclos vitales. Bogotá, Colombia: Ministerio de Salud; 1995.

  27. Gossec L, Tubach F, Dougados M. Ravaud P. Reporting of adherence to medication in recent randomized controlled trials of 6 chronic diseases: a systematic literature review. Am J Med Sci 2007;334:248-254.

  28. Gerstein HC, Riddle MC, Kendall DM, Cohen RM, Goland R, Feinglos MN, et al. Glycemia treatment strategies in the action to control cardiovascular risk in diabetes (ACCORD) trial. Am J Cardiol 2007;99:34i-43i.

  29. Beaton SJ, Nag SS, Gunter MJ, Gleeson JM, Sajjan SS, Alexander CM. Adequacy of glycemic, lipid, and blood pressure management for patients with diabetes in a managed care setting. Diabetes Care 2004;27:694-698.

  30. Cruz M, Tovar OO. Grado de control metabólico en un grupo de pacientes diabéticos del Hospital General San Felipe. Rev Med Post Grados Med UNAH 2007;10:144-149.

  31. Kemp TM, Barr EL, Zimmet PZ, Cameron AJ, Welborn TA, Colagiuri S, et al. Glucosa, lipid, and blood pressure control in Australian adults with type 2 diabetes. Diabetes Care 2005;28:1490-1492.

  32. Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, et al; VADT Investigators. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 2009;360:129-139.

  33. Chiu YW, Chang JM, Lin LI, Chang PY, Lo WC, Wu LC, et al. Adherence to a diabetic care plan provides better glycemic control in ambulatory patients with type 2 diabetes. Kaohsiung J Med Sci 2009;25:184-192.

  34. Rozenfeld Y, Hunt JS, Plauschinat C, Wong KS. Oral antidiabetic medication adherence and glycemic control in managed care. Am J Manag Care 2008;14:71-75.

  35. Cohen A, Horton ES. Progress in the treatment of type 2 diabetes: new pharmacologic approaches to improve glycemic control. Curr Med Res Opin 2007;23(4):905-917.

  36. Vaaler S. Optimal glycemic control in type 2 diabetic patients. Does including insulin treatment mean a better outcome? Diabetes Care 2000;23 Suppl 2:B30-B34.

  37. Ilkova H, Glaser B, Tunçkale A, Bagriaçik N, Cerasi E. Induction of long-term glycemic control in newly diagnosed type 2 diabetic patients by transient intensive insulin treatment. Diabetes Care 1997;20:1353-1356.

  38. Morello CM. Etiology and natural history of diabetic retinopathy: an overview. Am J Health Syst Pharm 2007;64(17 suppl 12):S3-S7.

  39. Anderson BJ, Vangsness L, Connell A, Butler D, Goebel-Fabbri A, Laffel LM. Family conflict, adherence, and glycaemic control in youth with short duration type 1 diabetes. Diabet Med 2002;19:635-642.

  40. Weinger K, O’Donnell KA, Ritholz MD. Adolescent views of diabetes-related parent conflict and support: a focus group analysis. J Adolesc Health 2001;29:330-336.

  41. Guthrie DW, Bartsocas C, Jarosz-Chabot P, Konstantinova M. Psychosicial issues for children and adolescents with diabetes: overview and recommendations. Diabetes Spectrum 2003;16:7-12.

  42. Trief PM, Himes CL, Orendorff R, Weinstock RS. The marital relationship and psychosocial adaptation and glycemic control of individuals with diabetes. Diabetes Care 2001;24:1384-1389.

  43. Cárdenas L, Vallbona C, Baker S, Yusim S. Adult onset diabetes mellitus: glicemic control and family function. Am J Med Sci 1987;293:28-33.

  44. Konen JC, Summerson JH, Dignan MB. Family function, stress, and locus of control. Arch Fam Med 1993;2:393-402.

  45. Gowers SG, Jones JC, Kiana S, North CD, Price A. Family functioning: a correlate of diabetic control. J Child Psychol Psychiatry 1995;36:993-1001.

  46. Gersthe JF, Varenne H, Contento I. Post-diagnosis famlily adaptation influences glycemic control in women with type 2 diabetes mellitus. J Am Diet Assoc 2001;101:918-922.

  47. Valadez I, Alfaro N, Centeno G, Cabrera C. Diseño de un instrumento para evaluar apoyo familiar al diabético tipo 2. Invest Salud 2003;5:167-172.

  48. Smilkstein G. Validity and reliability of the family apgar as a test of family function. J Fam Pract 1982;5:303-311.

  49. Bellón JA, Delgado A, Luna del Castillo J, Lardelli P. Validity and reliability of the family-Apgar questionnarie on family function. Aten Primaria 1996;18:289-296.

  50. Alba LH, Alvarado R. Medicina familiar (Editorial). Univ Med 2009;50:140-142.

  51. Whitford DL, Roberts SH, Griffin S. Sustainability and effectiveness of comprehensive diabetes care to a district population. Diabet Med 2004;21:1221-1228.




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