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Antonio-Villa NE, García-Tuomola A, Almeda-Valdes P, Vidrio-Velázquez M, Islas-Ortega L, Madrigal-Sanromán JR, Zaballa-Lasso C, Martínez-Ramos-Méndez A, De la Garza-Hernández NE, Bustamante-Martínez JF, González-Galvez G, Valadez-Capetillo M, Sanchez-Ruiz KL, Castillo-Galindo C, Yepez-Rodríguez AE, Polanco-Preza MA, Ceballos-Macías JJ, Valenzuela-Montoya JC, Escobedo-Ortiz AR, Ferreira-Hermosillo A, Rodríguez-Sanchez E, Romero-Zazueta A, Miracle-López S, Figueroa-Andrade MH, Faradji RN. Glycemic control, treatment and complications in patients with type 1 diabetes amongst healthcare settings in Mexico. Diabetes Res Clin Pract 2021; 180:109038. [PMID: 34487758 DOI: 10.1016/j.diabres.2021.109038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 08/11/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022]
Abstract
AIMS Type 1 diabetes (T1D) is a growing chronic disease. Evidence of whether the healthcare setting affects management and glycemic control is scarce. We evaluate outcomes in patients with T1D in private and public healthcare settings in Mexico, registered in the National T1D Registry in Mexico (RENACED-DT1). METHODS Biochemical parameters, diabetes education, and treatment were analyzed considering the data registered in the last visit. Development of chronic complications was determined during follow-up. RESULTS We included 1,603 patients; 71.5% (n = 1,146) registered in the public system, and 28.5% (n = 457) in a private institution. Patients in the public setting had higher HbA1c (8.6%, IQR: 7.3%-10.5% vs 7.7%, IQR: 7.0%-8.8%; p < 0.001). Indicators of diabetes education, glucose monitoring, and use of insulin-pumps were lower in the public setting. Patients in the public setting were at higher risk of diabetic chronic kidney disease, retinopathy, and neuropathy. Diabetes knowledge was a mediator between type of healthcare setting and the likelihood of achieving glycemic control. CONCLUSIONS Patients registered in public healthcare settings have an adverse metabolic profile and higher risk of complications. Social factors need to be addressed in order to implement multidisciplinary measures focused on diabetes education for patients with T1D in Mexico.
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Affiliation(s)
- Neftali Eduardo Antonio-Villa
- MD/PhD (PECEM), Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico; Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Aili García-Tuomola
- Departamento de Endocrinología y Metabolismo. Instituto Nacional de Ciencias Médicas y Nutrición"Salvador Zubirán, Mexico City, Mexico; Endocrinology, Centro Medico ABC, Mexico City, Mexico
| | - Paloma Almeda-Valdes
- Unidad de Investigación de Enfermedades Metabólicas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Departamento de Endocrinología y Metabolismo. Instituto Nacional de Ciencias Médicas y Nutrición"Salvador Zubirán, Mexico City, Mexico
| | | | - Laura Islas-Ortega
- Pediatric Endocrinology, Hospital del Niño DIF Hidalgo, Pachuca, Hidalgo, Mexico
| | | | | | | | | | - Jorge F Bustamante-Martínez
- Internal Medicine Department, Servicios de Salud de Nayarit, Hospital General de Tepic, Tepic, Nayarit, Mexico
| | - Guillermo González-Galvez
- Endocrinology, Instituto Jalisciense de Investigación en Diabetes y Obesidad S. C, Guadalajara, Jalisco, Mexico
| | | | - Karla L Sanchez-Ruiz
- Clínica de Diabetes, Secretaría de Salud del Estado de Durango, Durango, Durango, Mexico
| | | | | | - Miguel A Polanco-Preza
- Endocrinology Service, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico
| | | | - Julio C Valenzuela-Montoya
- Pediatric Endocrinology, Hospital De Gineco-Pediatría No. 31 IMSS, Mexicali, Baja California Norte, Mexico
| | - Ana R Escobedo-Ortiz
- Endocrinology, Hospital General Dr. Miguel Silva, Secretaria de Salud, Morelia, Michoacán, Mexico
| | - Aldo Ferreira-Hermosillo
- Endocrinology, Unidad de Investigación Médica en Enfermedades Endocrinas. Centro Médico Nacional Siglo XXI, IMSS, Mexico
| | | | | | - Sigfrido Miracle-López
- Endocrinology, Hospital Angeles Lomas, Huixquilucan, México; Associate Investigator, Centro de Investigación en Ciencias de la Salud (CICSA) Universidad, Anáhuac, Mexico
| | | | - Raquel N Faradji
- Endocrinology and Diabetes, Clinica EnDi, Mexico City, Mexico; Endocrinology, Centro Medico ABC, Mexico City, Mexico.
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