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Objective: Investigate the quality of diabetes care in patients treated for ophthalmologic complications in Mexico and its contribution. Patients and methods: Agreements were made to provide structured diabetes education to patients seeking specialized treatment at the 3 largest Ophtalmology hospitals, and at a public tertiary level hospital, in Mexico city. Patients were invited to attend group diabetes education sessions provided by certified diabetes educators, with the main objective to improve their self-care knowledge and abilities as a means to increase metabolic control and the outcomes of ophthalmologic therapy. As a requirement to attend the sessions, each patient received a survey in which history of diabetes, diagnostic methods, glycemic control, treatment, and chronic complications was investigated. Results: 300 patients were analyzed for this report: 171 females and 129 males. Despite that these hospitals are devoted to treat persons without social security, 43.6% of the patients had this type of care. Comparative percentages, odds ratios (OR) and statistical significance regarding glycemic control, treatment, and complications in patients with social security and without social security, in some of the variables investigated are shown in the table: Conclusions: The results of this survey clearly demonstrate that poor quality of diabetes care is a leading contributing factor in the pathogenesis of ophthalmologic complications. In Mexico, glycemic control is based on fasting and capillary casual measurements; A1c is rarely used. Albeit patients with social security have more access to drug therapy, differences with uninsured patients are not significant. Overall, quality of diabetes care is worse in recipients of social security in Mexico than in patients without access to these services; 40% of the patients should be receiving this type of specialized care at the institution that charges to provide health services. Rates of diabetic foot and current smokers are significantly higher in insured than in noninsured patients. [ABSTRACT FROM AUTHOR]

Objective: To survey a large sample of type 2 diabetes mellitus (T2DM) patients in Mexico City to determine if patient experience, access to basic services, treatment, and outcomes differed between those with social security coverage and those without., Methods: From 2001-2007 a total of 1 000 individuals with T2DM were surveyed in outpatient clinics of the three largest public ophthalmology hospitals in Mexico City. Patients reported information about their health status and receipt of basic diabetes services, such as laboratory glycemic monitoring and diabetes education. Rates were compared between those with (n = 461) and without (n = 539) social security., Results: Almost half of the patients (46%) in these public facilities were social security patients that were unable to access other services and had to pay out-of-pocket for care. Half of respondents were originally identified as potentially diabetic based on symptom complaints (51%), including 11% with visual impairment. Most patients (87.9%) reported that their glycemic level was being monitored exclusively via fasting blood glucose testing or random capillary blood glucose tests; only 5.3% reported ever having a glycated hemoglobin test. While nearly all respondents reported an individual physician encounter ever, only 39% reported ever receiving nutrition counseling and only 21% reported attending one or more sessions of diabetes education in their lifetime. Processes of care and outcomes were no different in patients with and those without social security coverage., Conclusions: In Mexico, the quality of diabetes care is poor. Despite receiving social security, many patients still have to pay out-of-pocket to access needed care. Without policy changes that address these barriers to comprehensive diabetes management, scientific achievements in diagnosis and pharmacotherapy will have limited impact.