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[Poor metabolic control in primary care]

[Poor metabolic control in primary care]

Authors :
Niels H, Wacher
Mara, Silva
Leticia, Valdez
Miguel, Cruz
Rita A, Gómez-Díaz
Source :
Gaceta medica de Mexico. 152(3)
Publication Year :
2016

Abstract

Poor metabolic control is a constant in patients with diabetes worldwide, despite resources demonstrated to achieve therapeutic targets. The object of this study was to identify causes of poor metabolic control in patients with diabetes treated in Family Medicine Clinics in metropolitan Mexico City at the Instituto Mexicano del Seguro Social.We analyzed 638 of 1,170 patients studied between 2000 and 2006. Anthropometric variables, occurrence of infections, treatment adherence, medical prescriptions, diet, exercise, and laboratory results were recorded.The proportion of patients with HbA1c7% worsened over time: from 38.9% at baseline it decreased to 21.4% (p0.001); LDL cholesterol decreased from 51.9 to 12.2% (p0.001), and controlled blood pressure from 35.6 to 23.3% (p0.001). A diet high in calories was associated with poor metabolic control (OR: 2.36; 95% CI: 1.34-4.13) and treatment intensification with elevated HbA1c (OR: 2.1; 95% CI: 1.14-4.14). Treatment was not intensified in 90% of patients outside targets. Infections, non-adherence, and drugs that interfere with oral hypoglycemic agents were not associated with higher HbA1c.The main factors associated with higher HbA1c were: disease progression, an inadequate diet, and lack of treatment intensification. Any program designed to improve the conditions of these patients must consider these factors.

Details

ISSN :
00163813
Volume :
152
Issue :
3
Database :
OpenAIRE
Journal :
Gaceta medica de Mexico
Accession number :
edsair.pmid..........5b575352ac18ac69a764d5b89b6173eb