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Elgart JF, Torrieri R, Ré M, Salazar M, Espeche W, Angelini JM, Martínez C, Martínez J, Giampieri C, Etchegoyen G, Ricart JP, Rodríguez ME, Gagliardino JJ. Prediabetes is more than a pre-disease: additional evidences supporting the importance of its early diagnosis and appropriate treatment. Endocrine 2023; 79:80-85. [PMID: 36352336 DOI: 10.1007/s12020-022-03249-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/31/2022] [Indexed: 11/10/2022]
Abstract
AIM To identify Prediabetes (PreD) as early and serious diabetes step using clinical-biochemical characteristics in the population of the Primary Prevention Diabetes Buenos Aires (PPDBA) study. METHODS PPDBA Study evaluated benefits of adopting healthy lifestyles to prevent T2D. It recruited people 45-75 years of age with PreD (impaired fasting glycaemia [IFG], impaired glucose tolerance [IGT] or both, American Diabetes Association criteria), using an opportunistic approach. They completed a FINDRISC questionnaire, and those with a score ≥13 points were invited to participate. When they accepted, we performed an oral glucose tolerance test (OGTT) with a complete lipid profile and HbA1c while physicians completed a clinical history. We recruited 367 persons, and depending on OGTT results, the sample was divided into normals (NGT), PreD, or with diabetes (last one was excluded in our analysis). Data were statistically analyzed using parametric and nonparametric tests and logistic regression to identify parameters associated with PreD. RESULTS From the recruited (n = 367) 47.7% have NGT, 48.5% PreD and 3.8% unknown T2D (excluded). People with PreD were significantly older, with a higher percentage of overweight/obesity, BMI, and larger waist circumference than NGT. They also showed significantly higher fasting and 2 h post glucose load, HbA1c, and triglyceride levels. No significant differences were recorded in the blood pressure, lipid profile though both groups had abnormally high LDL-c values. They also had a larger percentage of TG/HDL-c ratios (insulin resistance indicator) (55% vs. 37.5%). Logistic regression analysis showed that PreD was significant associated with age, waist circumference, and triglyceride above target values. CONCLUSION Our findings showed that clinical and biochemical parameters were significantly different between people with PreD and those with NGT. This evidence supports the concept that PreD is a serious dysfunction, which should be early diagnosed and treated properly to prevent its transition to T2D and its complications.
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Affiliation(s)
- J F Elgart
- CENEXA. Center for Experimental and Applied Endocrinology (UNLP-CONICET, CA CICPBA), Faculty of Medical Sciences UNLP, La Plata, Argentina
| | - R Torrieri
- CENEXA. Center for Experimental and Applied Endocrinology (UNLP-CONICET, CA CICPBA), Faculty of Medical Sciences UNLP, La Plata, Argentina
| | - M Ré
- CENEXA. Center for Experimental and Applied Endocrinology (UNLP-CONICET, CA CICPBA), Faculty of Medical Sciences UNLP, La Plata, Argentina
| | - M Salazar
- Cardiometabolic Unit, Hospital Gral. San Martín, La Plata, Argentina
- Faculty of Medical Sciences, National University of La Plata (UNLP), La Plata, Argentina
| | - W Espeche
- Cardiometabolic Unit, Hospital Gral. San Martín, La Plata, Argentina
- Faculty of Medical Sciences, National University of La Plata (UNLP), La Plata, Argentina
| | - J M Angelini
- Faculty of Medical Sciences, National University of La Plata (UNLP), La Plata, Argentina
| | - C Martínez
- Faculty of Medical Sciences, National University of La Plata (UNLP), La Plata, Argentina
| | - J Martínez
- Faculty of Medical Sciences, National University of La Plata (UNLP), La Plata, Argentina
| | - C Giampieri
- CENEXA. Center for Experimental and Applied Endocrinology (UNLP-CONICET, CA CICPBA), Faculty of Medical Sciences UNLP, La Plata, Argentina
| | - G Etchegoyen
- Chair of Epidemiology, Faculty of Medical Sciences (UNLP), La Plata, Argentina
| | - J P Ricart
- CENEXA. Center for Experimental and Applied Endocrinology (UNLP-CONICET, CA CICPBA), Faculty of Medical Sciences UNLP, La Plata, Argentina
| | - M E Rodríguez
- Faculty of Medical Sciences, National University of La Plata (UNLP), La Plata, Argentina
| | - J J Gagliardino
- CENEXA. Center for Experimental and Applied Endocrinology (UNLP-CONICET, CA CICPBA), Faculty of Medical Sciences UNLP, La Plata, Argentina.
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Calderon-Ticona JR, Taype-Rondan A, Villamonte G, Labán-Seminario LM, Helguero-Santín LM, Miranda JJ, Lazo-Porras M. Diabetes care quality according to facility setting: A cross-sectional analysis in six Peruvian regions. Prim Care Diabetes 2021; 15:488-494. [PMID: 33358034 DOI: 10.1016/j.pcd.2020.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 11/19/2020] [Accepted: 11/29/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To characterize diabetes care across healthcare facilities in six Peruvian regions. METHODS Cross-sectional study of patients with type 2 diabetes mellitus (T2DM), ranging from primary care facilities to hospital-based facilities, in six Peruvian regions. Data was collected by health staff trained between 2012 and 2016. We studied six diabetes care outcomes and four adequate diabetes care outcomes considering the healthcare facility as the exposure of interest. We estimated prevalence ratios (PR) and their 95% confidence intervals (95% CI) using Poisson regression with robust variance. RESULTS Data from 8879 patients with T2DM, mean age 59.1 years (SD ± 12.2), 53.6% males, was analyzed. Of these, 8096 (91.2%) were treated at primary care facilities. The proportions of patients who had HbA1c, LDL-c, and creatinine/microalbumin test performed increased with the setting of the healthcare facility. Overall, 39%-56% of patients had an adequate HbA1c control, being higher in hospital-based facilities with specialists in comparison to primary care facilities. CONCLUSIONS We observed that the higher the setting of the facility, the higher the rate of the assessed diabetes care outcomes and adequate diabetes care for four of the six targets (fasting glucose, HbA1c, LDL-c and creatinine or microalbumin) and for three of the four targets (glucose≤130 mg/dL, HbA1c ≤7%(53 mmol/mol) and LDL-c <100 mg/dL), respectively. Substantial gaps were observed at the primary care facilities, calling for the strengthening of diabetes care.
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Affiliation(s)
- Jorge R Calderon-Ticona
- Endocrinology Service, Hospital Nacional Arzobispo Loayza, Ministerio de Salud, Lima, Peru; School of Medicine, Universidad Nacional Mayor de San Marcos, Lima Peru.
| | - Alvaro Taype-Rondan
- CRONICAS Center of Excellence in Chronic Disease, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - L Max Labán-Seminario
- CRONICAS Center of Excellence in Chronic Disease, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Disease, Universidad Peruana Cayetano Heredia, Lima, Peru; School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria Lazo-Porras
- CRONICAS Center of Excellence in Chronic Disease, Universidad Peruana Cayetano Heredia, Lima, Peru; Division of Tropical and Humanitarian Medicine, Geneva University Hospitals & University of Geneva, Switzerland.
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Avilés-Santa ML, Monroig-Rivera A, Soto-Soto A, Lindberg NM. Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent. Curr Diab Rep 2020; 20:62. [PMID: 33037442 PMCID: PMC7546937 DOI: 10.1007/s11892-020-01341-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Latin America is the scenario of great inequalities where about 32 million human beings live with diabetes. Through this review, we aimed at describing the current state of the prevalence, awareness, treatment, and control of diabetes mellitus and completion of selected guidelines of care across Latin America and identify opportunities to advance research that promotes better health outcomes. RECENT FINDINGS The prevalence of diabetes mellitus has been consistently increasing across the region, with some variation: higher prevalence in Mexico, Haiti, and Puerto Rico and lower in Colombia, Ecuador, Dominican Republic, Peru, and Uruguay. Prevalence assessment methods vary, and potentially underestimating the real number of persons with diabetes. Diabetes unawareness varies widely, with up to 50% of persons with diabetes who do not know they may have the disease. Glycemic, blood pressure, and LDL-C control and completion of guidelines to prevent microvascular complications are not consistently assessed across studies, and the achievement of control goals is suboptimal. On the other hand, multiple interventions, point-of-care/rapid assessment tools, and alternative models of health care delivery have been proposed and tested throughout Latin America. The prevalence of diabetes mellitus continues to rise across Latin America, and the number of those with the disease may be underestimated. However, some local governments are embedding more comprehensive diabetes assessments in their local national surveys. Clinicians and public health advocates in the region have proposed and initiated various multi-level interventions to address this enormous challenge in the region.
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Affiliation(s)
- M Larissa Avilés-Santa
- Division of Extramural Scientific Programs, Clinical and Health Services Research at the National Institute on Minority Health and Health Disparities, Bethesda, MD, USA.
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Barrera-Guarderas F, De la Torre-Cisneros K, Barrionuevo-Tapia M, Cabezas-Escobar C. Evaluating the effectiveness of a support programme for people with type 2 diabetes mellitus in primary care: an observational prospective study in Ecuador. BJGP Open 2020; 4:bjgpopen20X101025. [PMID: 32317264 PMCID: PMC7330222 DOI: 10.3399/bjgpopen20x101025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 10/24/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The success of primary health care relies on the integration of empowered practitioners with cooperative patients regardless of socioeconomic status. Using resources efficiently would help to improve healthcare promotion and reduce complications of chronic non-communicable diseases (NCDs). The importance of network support programmes relies on the fact that they allow to accurately deliver medical care by shaping a sense of community and purpose among the patients. AIM To evaluate the effectiveness of a network support programme for patients with type 2 diabetes mellitus (T2DM). DESIGN & SETTING A centre-based observational prospective study took place in a primary care setting in Ecuador. METHOD The impact of the diabetes care programme was assessed by comparing initial and final metabolic characteristics and outcomes of 593 patients with T2DM, followed-up from April 2007 to December 2017, using paired sample t-test. Electrocardiograms (ECGs), ankle-brachial indexes (ABIs), ocular fundus, and monofilament neuropathy tests were assessed with the McNemar test to evaluate complications at the beginning and end of the study. RESULTS Glycated haemoglobin (HbA1c), lipid profile, and systolic blood pressure (SBP) showed statistically significant decreases between the initial measurement (IMs) and final measurements (FMs). In the FM, significantly lower HbA1c, diastolic blood pressure (DBP), and atherogenic index were found. Despite the length of time since diagnosis, during the follow-up time, long-term micro- and macro-vascular complications, such as ocular fundus, serum creatinine, and ABI, remained unchanged throughout the period of active participation in this healthcare programme. CONCLUSION This study demonstrates the feasibility of reducing plasma glucose, plasma lipids, and long-term complications in patients with T2DM by implementing a network support programme, which involves the medical team and patients themselves in an environment with limited resources.
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Elgart JF, Silvestrini C, Prestes M, Gonzalez L, Rucci E, Gagliardino JJ. Drug treatment of type 2 diabetes: Its cost is significantly associated with HbA1c levels. Int J Clin Pract 2019; 73:e13336. [PMID: 30811770 DOI: 10.1111/ijcp.13336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/06/2019] [Accepted: 02/24/2019] [Indexed: 12/15/2022] Open
Abstract
AIMS To examine the relationship between costs of hyperglycaemia drug treatment and glycemic control amongst people with type 2 diabetes (T2D). METHODS This observational study utilised data from the QUALIDIAB database on 3,452 T2D patients seen in Diabetes Centers in Argentina. Patients were classified according to their HbA1c value into two groups: on target (OT; HbA1c ≤ 7%), and not on target (NOT; HbA1c > 7%); within each category we considered clinical and metabolic indicators, as well as type of hyperglycaemia treatment. Monthly expenditure on drugs was estimated by micro-costing. Multivariable regression analysis was used to evaluate the association between cost of hyperglycaemia treatment and HbA1c values. RESULTS In total, 48.9% of the participants have HbA1c OT values. Overall monthly per capita costs of this treatment increased significantly (134%) in the NOT group. Multivariable regression analysis showed that expenditure for hyperglycaemia drugs treatment was significant associated with glycemic control (OR: 0.705), diabetes duration (OR: 1.017), systolic blood pressure (OR: 1.006) and treatment of T2D (OR: 2.622). CONCLUSIONS HbA1c NOT significantly increases drugs monthly cost of hyperglycaemia treatment in people with T2D in a country with an emerging market economy.
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Affiliation(s)
- Jorge F Elgart
- CENEXA. Center of Experimental and Applied Endocrinology (UNLP-CONICET), School of Medicine, National University of La Plata, La Plata, Argentina
| | - Constanza Silvestrini
- CENEXA. Center of Experimental and Applied Endocrinology (UNLP-CONICET), School of Medicine, National University of La Plata, La Plata, Argentina
| | - Mariana Prestes
- CENEXA. Center of Experimental and Applied Endocrinology (UNLP-CONICET), School of Medicine, National University of La Plata, La Plata, Argentina
| | - Lorena Gonzalez
- CENEXA. Center of Experimental and Applied Endocrinology (UNLP-CONICET), School of Medicine, National University of La Plata, La Plata, Argentina
- School of Health Economics and Management of Healthcare Organizations, Faculty of Economic Sciences, National University of La Plata, La Plata, Argentina
| | - Enzo Rucci
- CENEXA. Center of Experimental and Applied Endocrinology (UNLP-CONICET), School of Medicine, National University of La Plata, La Plata, Argentina
- III-LIDI, Faculty of Informatics, National University of La Plata, La Plata, Argentina
| | - Juan J Gagliardino
- CENEXA. Center of Experimental and Applied Endocrinology (UNLP-CONICET), School of Medicine, National University of La Plata, La Plata, Argentina
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Elgart JF, Prestes M, Gonzalez L, Rucci E, Gagliardino JJ. Relation between cost of drug treatment and body mass index in people with type 2 diabetes in Latin America. PLoS One 2017; 12:e0189755. [PMID: 29261739 PMCID: PMC5738071 DOI: 10.1371/journal.pone.0189755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/03/2017] [Indexed: 11/21/2022] Open
Abstract
AIMS Despite the frequent association of obesity with type 2 diabetes (T2D), the effect of the former on the cost of drug treatment of the latest has not been specifically addressed. We studied the association of overweight/obesity on the cost of drug treatment of hyperglycemia, hypertension and dyslipidemia in a population with T2D. METHODS This observational study utilized data from the QUALIDIAB database on 3,099 T2D patients seen in Diabetes Centers in Argentina, Chile, Colombia, Peru, and Venezuela. Data were grouped according to body mass index (BMI) as Normal (18.5≤BMI<25), Overweight (25≤BMI<30), and Obese (BMI≥30). Thereafter, we assessed clinical and metabolic data and cost of drug treatment in each category. Statistical analyses included group comparisons for continuous variables (parametric or non-parametric tests), Chi-square tests for differences between proportions, and multivariable regression analysis to assess the association between BMI and monthly cost of drug treatment. RESULTS Although all groups showed comparable degree of glycometabolic control (FBG, HbA1c), we found significant differences in other metabolic control indicators. Total cost of drug treatment of hyperglycemia and associated cardiovascular risk factors (CVRF) increased significantly (p<0.001) with increment of BMI. Hyperglycemia treatment cost showed a significant increase concordant with BMI whereas hypertension and dyslipidemia did not. Despite different values and percentages of increase, this growing cost profile was reproduced in every participating country. BMI significantly and independently affected hyperglycemia treatment cost. CONCLUSIONS Our study shows for the first time that BMI significantly increases total expenditure on drugs for T2D and its associated CVRF treatment in Latin America.
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Affiliation(s)
- Jorge Federico Elgart
- CENEXA. Center of Experimental and Applied Endocrinology (UNLP-CONICET La Plata), School of Medicine, National University of La Plata, La Plata, Argentina
| | - Mariana Prestes
- CENEXA. Center of Experimental and Applied Endocrinology (UNLP-CONICET La Plata), School of Medicine, National University of La Plata, La Plata, Argentina
| | - Lorena Gonzalez
- CENEXA. Center of Experimental and Applied Endocrinology (UNLP-CONICET La Plata), School of Medicine, National University of La Plata, La Plata, Argentina
- School of Health Economics and Management of Healthcare Organizations, Faculty of Economic Sciences, National University of La Plata, La Plata, Argentina
| | - Enzo Rucci
- CENEXA. Center of Experimental and Applied Endocrinology (UNLP-CONICET La Plata), School of Medicine, National University of La Plata, La Plata, Argentina
- III-LIDI, Faculty of Informatics, National University of La Plata, La Plata, Argentina
| | - Juan Jose Gagliardino
- CENEXA. Center of Experimental and Applied Endocrinology (UNLP-CONICET La Plata), School of Medicine, National University of La Plata, La Plata, Argentina
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Asteazaran S, Gagliardino JJ, Elgart JF. Health inequalities and the impact on the prevalence of cardiovascular risk factors and chronic complications in Argentina: a study on national risk factors surveys. Medwave 2017; 17:e7083. [PMID: 29194433 DOI: 10.5867/medwave.2017.09.7083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 10/10/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND In Argentina, there is evidence of health inequalities, measured both at the general level and also using income as a parameter of social status. However, few studies address the issue of health equality in chronic diseases such as cardiovascular risk factors. OBJECTIVE To describe health inequalities, using cardiovascular risk factors as a tracer for chronic diseases in different areas of the country and over time. In addition, we aim to identify differences in the quality of care provided to people with cardiovascular risk factors, between 2005 and 2009. METHODS This is an observational study, which used descriptive and quantitative methods. Data from the National Risk Factors Survey from 2005 and 2009 in the cohorts who have chronic diseases (hypertension, diabetes, dyslipidemia and overweight/obesity) were analyzed to assess associations between health status and several demographic, epidemiological and socioeconomic variables. Additionally, clinical and metabolic characteristics of people with diabetes and other cardiovascular risks factors were analyzed in 2005 and 2009 using the database Quality of Diabetes Care (QUALIDIAB). RESULTS Cardiovascular risk factors are more frequent in people with lower socioeconomic status, regardless of the indicator. The inequalities detected showed the worst indicators in strata with lower education and income, with the same results both nationwide and separated by region. This inequalities were more pronounced in 2009, and their magnitude changed by region and cardiovascular risk factor. From 2005 to 2009, body mass index, blood glucose and HbA1c value increased. In contrast, both systolic blood pressure and triglycerides decreased, with no significant changes in total cholesterol and diastolic blood pressure. CONCLUSION Cardiovascular risk factors present inequalities attributed to social status manifesting at both national and regional levels.
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Affiliation(s)
- Santiago Asteazaran
- Centro de Endocrinología Experimental y Aplicada CENEXA (UNLP-CONICET), Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina. Address: CENEXA (UNLP-CONICET), Facultad de Ciencias Médicas, cuarto piso, Universidad Nacional de La Plata, Calle 60 y 120 1900 ,La Plata, Argentina.
| | - Juan Jose Gagliardino
- Centro de Endocrinología Experimental y Aplicada CENEXA (UNLP-CONICET), Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina
| | - Jorge Federico Elgart
- Centro de Endocrinología Experimental y Aplicada CENEXA (UNLP-CONICET), Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata, Argentina
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Elgart JF, González L, Prestes M, Rucci E, Gagliardino JJ. Frequency of self-monitoring blood glucose and attainment of HbA1c target values. Acta Diabetol 2016; 53:57-62. [PMID: 25841589 DOI: 10.1007/s00592-015-0745-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/18/2015] [Indexed: 11/30/2022]
Abstract
AIMS Test strips for self-monitoring of blood glucose (SMBG) represent in Argentina, around 50 % of diabetes treatment cost; the frequency of their use is closely associated with hyperglycemia treatment. However, the favorable impact of SMBG on attainment of HbA1c goal in different treatment conditions remains controversial. We therefore attempted to estimate the relationship between use of SMBG test strips and degree of attainment of metabolic control in an institution of our social security subsector (SSS) in which provision is fully covered and submitted to a regular audit system. METHODS Observational retrospective study using information of 657 patients with T2DM (period 2009-2010) from the database of the Diabetes and Other Cardiovascular Risk Factors Program (DICARO) of one institution of our SSS. DICARO provides-with an audit system-100 % coverage for all drugs and keeps records of clinical, metabolic and treatment data from every patient. RESULTS The average monthly test strips/patient used for SMBG increased as a function of treatment intensification: Monotherapy with oral antidiabetic drugs (OAD) < combined OAD therapy < insulin treatment. In every condition, the number was larger in people with target HbA1c levels. Test strips represented the larger percentage of total prescription cost. CONCLUSIONS In our population, the type of hyperglycemia treatment was the main driver of test strip use for SMBG; in every condition tested, targeted HbA1c values were associated with greater strip use. Patient education and prescription audit may optimize its use and treatment outcomes.
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Affiliation(s)
- Jorge F Elgart
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET LA PLATA, Centro Colaborador de la OPS/OMS en Diabetes), Facultad de Ciencias Médicas UNLP, 60 y 120, 1900, La Plata, Argentina.
| | - Lorena González
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET LA PLATA, Centro Colaborador de la OPS/OMS en Diabetes), Facultad de Ciencias Médicas UNLP, 60 y 120, 1900, La Plata, Argentina.
- Escuela de Economía de la Salud y Administración de Organizaciones de Salud, Facultad de Ciencias Económicas, Universidad Nacional de La Plata (UNLP), La Plata, Argentina.
| | - Mariana Prestes
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET LA PLATA, Centro Colaborador de la OPS/OMS en Diabetes), Facultad de Ciencias Médicas UNLP, 60 y 120, 1900, La Plata, Argentina.
| | - Enzo Rucci
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET LA PLATA, Centro Colaborador de la OPS/OMS en Diabetes), Facultad de Ciencias Médicas UNLP, 60 y 120, 1900, La Plata, Argentina.
- III-LIDI, Facultad de Informática, Universidad Nacional de La Plata (UNLP), La Plata, Argentina.
| | - Juan J Gagliardino
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET LA PLATA, Centro Colaborador de la OPS/OMS en Diabetes), Facultad de Ciencias Médicas UNLP, 60 y 120, 1900, La Plata, Argentina.
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Quality of Diabetes Care: The Challenges of an Increasing Epidemic in Mexico. Results from Two National Health Surveys (2006 and 2012). PLoS One 2015; 10:e0133958. [PMID: 26230991 PMCID: PMC4521912 DOI: 10.1371/journal.pone.0133958] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 07/04/2015] [Indexed: 01/09/2023] Open
Abstract
Background The quality of diabetes care remains suboptimal according to numerous studies assessing the achievement of quality indicators for diabetes care in various healthcare settings. We report about global and specific quality indicators for diabetes care and their association to glycemic control at the population level in two national health surveys in Mexico. Methods We conducted a cross-sectional analysis of the 2006 and 2012 National Health Surveys in Mexico. We examined quality of care for 2,965 and 4,483 adults (≥ 20 years) with diagnosed type 2 diabetes using fourteen simple and two composite indicators derived from self-reported information. In a subsample for both surveys, glycated hemoglobin (HbA1c) was measured at the time of the interview. We obtained survey weight-adjusted estimators using multiple regression models (logistic and linear) with combined data files, including survey year as covariate to assess change. Results Global quality of care in 2012 was 40.8%, with a relative improvement of 11.7% between 2006 and 2012. Detections of cardiovascular disease risk factors (dyslipidemia and hypertension) were the indicators with the highest improvement, while non-pharmaceutical treatment and diabetic foot exams showed minor changes. We found a significant association between the quality of the process of diabetes care and glycemic control (OR 2.53, 95% CI 1.63-3.94). Age more than 65 years old, the type of health subsystem, gender (males), and high socio-economic status were also significantly associated to glycemic control. Conclusions Quality diabetes care and glycemic control improved and are significantly associated. However, according to international standards, the current situation remains suboptimal. A more holistic approach is needed, with an emphasis on improving quality in outpatient care.
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Pichon-Riviere A, Irazola V, Beratarrechea A, Alcaraz A, Carrara C. Quality of life in type 2 diabetes mellitus patients requiring insulin treatment in Buenos Aires, Argentina: a cross-sectional study. Int J Health Policy Manag 2015; 4:475-80. [PMID: 26188812 DOI: 10.15171/ijhpm.2015.80] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 04/06/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Decision-makers have begun to recognize Health-Related Quality of Life (HRQoL) as an important and measurable outcome of healthcare interventions; and HRQoL data is increasingly being used by policy-makers to prioritize health resources. Our objective was to measure HRQoL in a group of Type 2 Diabetes Mellitus (T2DM) patients receiving insulin treatment in Buenos Aires, Argentina. METHODS We conducted a cross-sectional study of patients with T2DM over 21 years of age, treated with either Neutral Protamine Hagedorn (NPH) insulin or Insulin Glargine (IG), who had not changed their baseline schedule in the last 6 months. The recruitment was during 2006-7 in nine private diabetes specialists' offices in Buenos Aires, Argentina. A standardized diabetes-specific HRQoL questionnaire, the Audit of Diabetes Dependent Quality of Life (ADDQoL), was used. RESULTS A total of 183 patients were included (93 receiving NPH and 90 receiving IG). The mean QoL score was: 0.98 (SD: 0.89) and the diabetes specific QoL was: -1.49 (SD: 0.90). T2DM had a negative impact on HRQoL with a mean Average Weighted Impact (AWI) score on QoL of -1.77 (SD: 1.58). The greatest negative impact was observed for domains: 'worries about the future', 'freedom to eat', 'living conditions', 'sex life', and 'family life'. The mean AWI score was -1.71 (SD: 1.48) in patients treated with IG and -1.85 (SD: 1.68) in patients receiving NPH, this difference was not statistically significant. CONCLUSION The ADDQoL questionnaire is a tool that can be used in Argentina to measure the QoL of patients with diabetes when evaluating diabetes care programs. The scores of QoL in our selected population did not differ from those reported in high-income countries. We expect that the results of this study will increase healthcare providers' awareness of patients' perceived QoL and help to overcome the barriers that delay insulin treatment; mainly clinical inertia and patient resistance.
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Affiliation(s)
- Andres Pichon-Riviere
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.,School of Public Health, University of Buenos Aires, Buenos Aires, Argentina
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Andrea Beratarrechea
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.,Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Andrea Alcaraz
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Carolina Carrara
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.,Family and Community Medicine Division Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Gonzalez L, Caporale JE, Elgart JF, Gagliardino JJ. The burden of diabetes in Argentina. Glob J Health Sci 2014; 7:124-33. [PMID: 25948443 PMCID: PMC4802096 DOI: 10.5539/gjhs.v7n3p124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 10/27/2014] [Accepted: 09/24/2014] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To measure the economic burden of diabetes in Argentina by age, gender and region for the year 2005, in disability-adjusted life years (DALYs). METHODS DALYs were estimated by the sum of years of life lost due to premature death (YLL) and years of life lived with disability (YLD). RESULTS In the population studied (20 to 85 years), the burden of diabetes without complications was 1.3 million DALYs, 85% of which were caused by disabilities. Whereas mortality rates (YLL) increased as a function of age, YLD showed the opposite relationship. Women had higher burden of disease values, represented by 51 and 61% of YLL and YLD, respectively, independently of age. CONCLUSIONS Our results demonstrate that disabilities are a key component of diabetes burden; its regular and systematic estimation would allow to design effective prevention strategies, to assess the impact of their implementation and to optimize resource allocation based on objective evidence.
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Affiliation(s)
| | | | | | - Juan J Gagliardino
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP - CONICET), Centro Colaborador de OPS/OMS para Diabetes, Facultad de Ciencias Médicas (UNLP), La Plata, Argentina.
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12
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Elgart JF, González L, Rucci E, Gagliardino JJ. Self-monitoring of blood glucose: use, frequency drivers, and cost in Argentina. J Diabetes Sci Technol 2014; 8:1121-5. [PMID: 25208965 PMCID: PMC4455458 DOI: 10.1177/1932296814549993] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although test strips for self-monitoring of blood glucose (SMBG) represent around 50% of diabetes treatment cost in Argentina, little is known about their current use and relationship with different types of treatment. We therefore aimed to estimate the current use of test strips and identify the major use drivers and the percentage they represent of total prescription costs in 2 entities of the social security system (SSS) of Argentina. Observational retrospective study measuring test strip prescriptions delivered by pharmacies from the province of Buenos Aires (8115 records collected during 3 months provided by the Colegio de Farmacéuticos de la Provincia de Buenos Aires) of affiliates with type 2 diabetes (T2DM) from 2 large entities of the SSS system. The average monthly test strips/patient used for SMBG was 97.5 ± 70.1. This number varied according to treatment: monotherapy with oral antidiabetic drugs (OAD) < combined OAD therapy < insulin treatment. Test strips represented a higher percentage of the total prescription cost in people under OAD monotherapy (84.6%) and lower in those with insulin analogs (46.9%). In our population, the type of hyperglycemia treatment was the main driver of test strip use for SMBG and its impact on the total prescription cost depends on the kind of such treatment. Since it has been shown that patients' education and prescription audit can optimize test strip use and treatment outcomes, implementation of such strategies could appropriately support, optimize, and reduce ineffective test strip use in people with T2DM.
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Affiliation(s)
- Jorge F Elgart
- CENEXA-Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET LA PLATA, Centro Colaborador de la OPS/OMS en Diabetes), Facultad de Ciencias Médicas UNLP, La Plata, Argentina
| | - Lorena González
- CENEXA-Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET LA PLATA, Centro Colaborador de la OPS/OMS en Diabetes), Facultad de Ciencias Médicas UNLP, La Plata, Argentina
| | - Enzo Rucci
- CENEXA-Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET LA PLATA, Centro Colaborador de la OPS/OMS en Diabetes), Facultad de Ciencias Médicas UNLP, La Plata, Argentina
| | - Juan J Gagliardino
- CENEXA-Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET LA PLATA, Centro Colaborador de la OPS/OMS en Diabetes), Facultad de Ciencias Médicas UNLP, La Plata, Argentina
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13
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Escalante M, Gagliardino JJ, Guzmán JR, Tschiedel B. Call-to-action: timely and appropriate treatment for people with type 2 diabetes in Latin America. Diabetes Res Clin Pract 2014; 104:343-52. [PMID: 24835577 DOI: 10.1016/j.diabres.2014.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 08/27/2013] [Accepted: 01/01/2014] [Indexed: 01/27/2023]
Abstract
Latin America faces a unique set of challenges in the treatment of type 2 diabetes mellitus (T2DM). This report identifies these challenges and provides a framework for implementation of the strategies, policies and education programs which are needed to optimize the management of this condition. In order to improve future diabetes care, it will be necessary to address existing problems such as limitation of resources, inadequate management of hyperglycemia, and inappropriate education of healthcare team members and people with diabetes. Achieving these goals will require collaborative efforts by many individuals, groups and organizations. These include policymakers, international organizations, healthcare providers, those responsible for setting medical school curricula, patients and society as a whole. It is anticipated that improved/continuing education of healthcare professionals, diabetes self-management education and development of a team approach for T2DM care will lead to optimization of patient-centered care. Implementation of multicentric demonstration studies and rational use of antidiabetic treatments will be necessary to demonstrate the long-term favorable impact of these strategies upon quality of care, prevention of chronic complications, mortality, healthcare costs and patient quality of life.
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Affiliation(s)
- Miguel Escalante
- Hospital de Especialidades, Centro Medico Nacional de Occidente, Mexican Institute of Social Security, Guadalajara, Mexico.
| | - Juan José Gagliardino
- CENEXA. Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET La Plata), PAHO/WHO Collaborating Centre for Diabetes, Facultad de Ciencias Médicas UNLP, La Plata, Argentina
| | - Juan Rosas Guzmán
- Centro de Especialidades Medicas de Celaya, Latin University of Mexico in Celaya, Guanajuato, Mexico
| | - Balduino Tschiedel
- Institute for Children with Diabetes in Porto Alegre and the Brazilian Diabetes Society, Porto Alegre, Brazil
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Caporale JE, Elgart JF, Gagliardino JJ. Diabetes in Argentina: cost and management of diabetes and its complications and challenges for health policy. Global Health 2013; 9:54. [PMID: 24168330 PMCID: PMC3826662 DOI: 10.1186/1744-8603-9-54] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 10/10/2013] [Indexed: 12/04/2022] Open
Abstract
Background Diabetes is an expensive disease in Argentina as well as worldwide, and its prevalence is continuously rising affecting the quality of life of people with the disease and their life expectancy. It also imposes a heavy burden to the national health care budget and on the economy in the form of productivity losses. Aims To review and discuss a) the reported evidence on diabetes prevalence, the degree of control, the cost of care and outcomes, b) available strategies to decrease the health and economic disease burden, and c) how the disease fits in the Argentinian health care system and policy. Finally, to propose evidence-based policy options to reduce the burden of diabetes, both from an epidemiological as well as an economic perspective, on the Argentinian society. The evidence presented is expected to help the local authorities to develop and implement effective diabetes care programmes. Methodology A comprehensive literature review was performed using databases such as MEDLINE, EMBASE and LILACS (Latin American and Caribbean Health Sciences). Literature published from 1980 to 2011 was included. This information was complemented with grey literature, including data from national and provincial official sources, personal communications and contacts with health authorities and diabetes experts in Argentina. Results Overall diabetes prevalence increased from 8.4% in 2005 to 9.6% 2009 at national level. In 2009, diabetes was the seventh leading cause of death with a mortality rate of 19.2 per 100,000 inhabitants, and it accounted for 1,328,802 DALYs lost in the adult population, mainly affecting women aged over fifty. The per capita hospitalisation cost for people with diabetes was significantly higher than for people without the disease, US$ 1,628 vs. US$ 833 in 2004. Evidence shows that implementation of combined educative interventions improved quality of care and outcomes, decreased treatment costs and optimised the use of economic resources. Conclusions Based on the evidence reviewed, we believe that the implementation of structured health care programmes including diabetes education at every level, could improve quality of care as well as its clinical, metabolic and economic outcomes. If implemented across the country, these programmes could decrease the disease burden and optimise the use of human and economic resources.
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Affiliation(s)
| | | | - Juan J Gagliardino
- CENEXA - Centro de Endocrinología Experimental y Aplicada (UNLP - CONICET La Plata, PAHO/WHO Collaborating Centre for Diabetes), Facultad de Ciencias Médicas UNLP, La Plata, Argentina.
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15
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Gagliardino JJ, Lapertosa S, Pfirter G, Villagra M, Caporale JE, Gonzalez CD, Elgart J, González L, Cernadas C, Rucci E, Clark C. Clinical, metabolic and psychological outcomes and treatment costs of a prospective randomized trial based on different educational strategies to improve diabetes care (PRODIACOR). Diabet Med 2013; 30:1102-11. [PMID: 23668772 DOI: 10.1111/dme.12230] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 03/12/2013] [Accepted: 05/07/2013] [Indexed: 01/11/2023]
Abstract
AIM To evaluate the effect of system interventions (formalized data collection and 100% coverage of medications and supplies) combined with physician and/or patient education on therapeutic indicators and costs in Type 2 diabetes. METHODS This was a randomized 2 × 2 design in public health, social security or private prepaid primary care clinics in Corrientes, Argentina. Thirty-six general practitioners and 468 adults with Type 2 diabetes participated. Patients of nine participating physicians were selected randomly and assigned to one of four structured group education programmes (117 patients each): control (group 1), physician education (group 2), patient education (group 3), and both physician education and patient education (group 4), with identical system interventions in all four groups. Outcome measures included HbA(1c), BMI, blood pressure, fasting glucose, lipid profile, drug consumption, resource use and patient well-being at baseline and every 6 months up to 42 months. RESULTS HbA(1c) decreased significantly from 4 mmol/mol to 10 mmol/mol by 42 months (P < 0.05); the largest and more consistent decrease was in the groups where patients and physicians were educated. Blood pressure and triglycerides decreased significantly in all groups; the largest changes were recorded in the combined education group. The World Health Organization-5 Lowe score showed significant improvements, without differences among groups. The lowest treatment cost was seen in the combined education group. CONCLUSIONS In a primary care setting, educational interventions combined with comprehensive care coverage resulted in long-term improvement in clinical, metabolic and psychological outcomes at the best cost-effectiveness ratio.
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Affiliation(s)
- J J Gagliardino
- CENEXA-Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET LA PLATA, Centro Colaborador de la OPS/OMS), Facultad de Ciencias Médicas UNLP, La Plata, Argentina.
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González L, Elgart JF, Calvo H, Gagliardino JJ. Changes in quality of care and costs induced by implementation of a diabetes program in a social security entity of Argentina. CLINICOECONOMICS AND OUTCOMES RESEARCH 2013; 5:337-45. [PMID: 23869172 PMCID: PMC3706253 DOI: 10.2147/ceor.s40949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To measure the impact of a diabetes and cardiovascular risk factors program implemented in a social security institution upon short- and long-term clinical/metabolic outcomes and costs of care. METHODS Observational longitudinal cohort analysis of clinical/metabolic data and resource use of 300 adult male and female program participants with diabetes before (baseline) and 1 and 3 years after implementation of the program. Data were obtained from clinical records (Qualidiab) and the administration's database. RESULTS The implementation of the program in "real world" conditions resulted in an immediate and sustainable improvement of the quality of care provided to people with diabetes incorporated therein. We also recorded a more appropriate oral therapy prescription for hyperglycemia and cardiovascular risk factors (CVRFs), as well as a decrease of events related to chronic complications. This improvement was associated with an increased use of diagnostic and therapeutic resources, particularly those related to pharmacy prescriptions, not specifically used for the control of hyperglycemia and other CVRFs. CONCLUSION The implementation of a diabetes program in real-world conditions results in a significant short- and long-term improvement of the quality of care provided to people with diabetes and other CVRFs, but simultaneously increased the use of resources and the cost of diagnostic and therapeutic practices. Since controlled studies have shown improvement in quality of care without increasing costs, our results suggest the need to include management-control strategies in these programs for appropriate medical and administrative feedback to ensure the simultaneous improvement of clinical outcomes and optimization of the use of resources.
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Affiliation(s)
- Lorena González
- Center of Experimental and Applied Endocrinology, National University of La Plata, La Plata, Argentina
| | - Jorge F Elgart
- Center of Experimental and Applied Endocrinology, National University of La Plata, La Plata, Argentina
| | - Héctor Calvo
- School of Economics and Management of Healthcare Organizations, National University of La Plata, La Plata, Argentina
| | - Juan J Gagliardino
- Center of Experimental and Applied Endocrinology, National University of La Plata, La Plata, Argentina
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Pérez-Cuevas R, Doubova SV, Suarez-Ortega M, Law M, Pande AH, Escobedo J, Espinosa-Larrañaga F, Ross-Degnan D, Wagner AK. Evaluating quality of care for patients with type 2 diabetes using electronic health record information in Mexico. BMC Med Inform Decis Mak 2012; 12:50. [PMID: 22672471 PMCID: PMC3437217 DOI: 10.1186/1472-6947-12-50] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 06/06/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several low and middle-income countries are implementing electronic health records (EHR). In the near future, EHRs could become an efficient tool to evaluate healthcare performance if appropriate indicators are developed. The aims of this study are: a) to develop quality of care indicators (QCIs) for type 2 diabetes (T2DM) in the Mexican Institute of Social Security (IMSS) health system; b) to determine the feasibility of constructing QCIs using the IMSS EHR data; and c) to evaluate the quality of care (QC) provided to IMSS patients with T2DM. METHODS We used a three-stage mixed methods approach: a) development of QCIs following the RAND-UCLA method; b) EHR data extraction and construction of indicators; c) QC evaluation using EHR data from 25,130 T2DM patients who received care in 2009. RESULTS We developed 18 QCIs, of which 14 were possible to construct using available EHR data. QCIs comprised both process of care and health outcomes. Several flaws in the EHR design and quality of data were identified. The indicators of process and outcomes of care suggested areas for improvement. For example, only 13.0% of patients were referred to an ophthalmologist; 3.9% received nutritional counseling; 63.2% of overweight/obese patients were prescribed metformin, and only 23% had HbA1c <7% (or plasma glucose≤130 mg/dl). CONCLUSIONS EHR data can be used to evaluate QC. The results identified both strengths and weaknesses in the electronic information system as well as in the process and outcomes of T2DM care at IMSS. This information can be used to guide targeted interventions to improve QC.
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Affiliation(s)
- Ricardo Pérez-Cuevas
- Division of Social Protection and Health, Inter-American Development Bank, Washignton, USA
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, México, DF, Mexico
| | - Magdalena Suarez-Ortega
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, México, DF, Mexico
| | - Michael Law
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - Aakanksha H Pande
- Department of Population Medicine and WHO Collaborating Center in Pharmaceutical Policy, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Jorge Escobedo
- Unidad de Investigación en Epidemiología Clínica, Hospital Regional 1 Carlos MacGregor Sánchez Navarro, IMSS, México, DF, México
| | | | - Dennis Ross-Degnan
- Department of Population Medicine and WHO Collaborating Center in Pharmaceutical Policy, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Anita K Wagner
- Department of Population Medicine and WHO Collaborating Center in Pharmaceutical Policy, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Trujillo AJ, Vecino Ortiz AI, Ruiz Gómez F, Steinhardt LC. Health insurance doesn't seem to discourage prevention among diabetes patients in Colombia. Health Aff (Millwood) 2011; 29:2180-8. [PMID: 21134918 DOI: 10.1377/hlthaff.2010.0463] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In the South American nation of Colombia, as elsewhere, patients with type 2 diabetes often avoid care that could prevent their condition from worsening. Availability of health insurance may play a role in explaining this behavior. Some patients with diabetes skip preventive measures because they have insurance and calculate that they can access curative services later in life. Insurers may limit preventive services coverage because they can't be assured of sharing in the eventual savings that emerge when a chronic condition such as diabetes is managed properly. Our analysis of a nationally representative sample of Colombians who have type 2 diabetes and who pay premiums into the country's "contributory" insurance program, found no evidence that insurance influences those individuals to avoid preventive services. The evidence is less clear for those participating in a different, fully subsidized insurance program, who-despite the availability of preventive care-are no more likely to seek preventive visits than are uninsured patients. We propose controlled experiments to identify and measure the true causal effects of insurance on prevention and, more broadly, steps to increase patients' understanding of the benefits of prevention.
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Affiliation(s)
- Antonio J Trujillo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland, USA.
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Peyrot M, Rubin RR, Lauritzen T, Skovlund SE, Snoek FJ, Matthews DR, Landgraf R. Patient and provider perceptions of care for diabetes: results of the cross-national DAWN Study. Diabetologia 2006; 49:279-88. [PMID: 16397792 DOI: 10.1007/s00125-005-0048-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2005] [Accepted: 08/30/2005] [Indexed: 01/08/2023]
Abstract
AIMS/HYPOTHESIS We assessed country-level and individual-level patterns in patient and provider perceptions of diabetes care. METHODS The study used a cross-sectional design with face-to-face or telephone interviews of diabetic patients and healthcare providers in 13 countries from Asia, Australia, Europe and North America. Participants were randomly selected adults with type 1 or type 2 diabetes (n=5,104), and randomly selected diabetes-care providers, including primary-care physicians (n=2,070), diabetes specialist physicians (n=635) and nurses (n=1,122). Multivariate analysis was used to examine the relationships between outcomes and both country and respondent characteristics, and the interaction between these two factors. RESULTS Providers rated chronic-care systems and remuneration for chronic care as mediocre. Patients reported that ease of access to care was high, but not without financial barriers. Patients reported moderate levels of collaboration among providers, and providers indicated that several specialist disciplines were not readily available to them. Patients reported high levels of collaboration with providers in their own care. Provider endorsement of primary prevention strategies for type 2 diabetes was high. Patients with fewer socio-economic resources and more diabetes complications had lower access (and/or higher barriers) to care and lower quality of patient-provider collaboration. Countries differed significantly for all outcomes, and the relationships between respondent characteristics and outcomes varied by country. CONCLUSIONS/INTERPRETATION There is much need for improvement in applying the chronic-care model to the treatment and prevention of diabetes in all of the countries studied. Each country must develop its own priorities for improving diabetes care and comparison with other countries can help identify strengths as well as weaknesses.
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Affiliation(s)
- M Peyrot
- Dept. of Sociology, Loyola College, 45021 North Charles Street, Baltimore, MD 21210-2699, USA.
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Burlando G, Sánchez RA, Ramos FH, Mogensen CE, Zanchetti A. Latin American consensus on diabetes mellitus and hypertension. J Hypertens 2004; 22:2229-41. [PMID: 15614013 DOI: 10.1097/00004872-200412000-00001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Diabetes mellitus and hypertension, responsible of a major burden of cardiovascular complications, are increasing their incidence in Latin America in similar proportions to the rest of the world. The metabolic syndrome, a strong predictor of both diabetes and hypertension deserves more attention from the primary care physicians. Evidence based and updated guidelines on detection, prevention and treatment of diabetes and hypertension, issued by local experts, are willing to inform and translate these recommendations to the clinical practice of physicians assisting these patients throughout Latin America.
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Thakurdesai PA, Kole PL, Pareek RP. Evaluation of the quality and contents of diabetes mellitus patient education on Internet. PATIENT EDUCATION AND COUNSELING 2004; 53:309-313. [PMID: 15186868 DOI: 10.1016/j.pec.2003.04.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2002] [Revised: 04/02/2003] [Accepted: 04/27/2003] [Indexed: 05/24/2023]
Abstract
Patient education is widely regarded as an essential component of chronic disease care and effective health promotion. Internet is extremely useful medium in this respect. Web-based information is seldom the subject of systematic investigation for its accuracy and appropriateness for patients. Objective of this study was to evaluate of web-based diabetes patient education material for well-accepted evaluation criteria and core education concepts. Out of 214 web-sites retrieved from meta search engine, 53 sites themselves provide patient information and so considered for evaluation. Data obtained was analyzed by cluster analysis and classified into four categories with respect to quality. Considerable variability in quality of diabetes patient education web-sites was found with respect to core educational concepts and HSWG criteria. Inclusion of evidence-based medicine concepts, role of family support, enhancement in customized content and easier feedback mechanism in the web-sites can be a significant development in the direction of patient-centered diabetes care.
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Affiliation(s)
- Prasad A Thakurdesai
- Pharmacy Group, Birla Institute of Technology and Science, Pilani 333031, Rajasthan, India.
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