[Quality of care in diabetic outpatient clinics]. / Avaliação da qualidade de cuidados numa consulta de diabetes.

UNLABELLED: Type 2 Diabetes Mellitus affects an increasing number of people throughout the world. Several studies have shown that it is possible to prevent and minimize type 2 diabetes complications, be it treated appropriately over time. This study aimed to determine the quality of care provided to type 2 diabetic patients in our institution, through metabolic control and risk factors evaluation. SUBJECTS AND METHODS: We reviewed the medical records of 776 type 2 diabetic patients, followed at our outpatient clinic between 1998-2004. RESULTS: A total of 588 patients were included in the study, with a mean age of 66,8 ± 27,2 years. 58% were men. HbA1c levels averaged 7,2 ± 1,6. 57% had HbA1c = 7%. 25,3% met the target blood pressure of 130/80 mmHg; 48% met the goal LDL cholesterol level < 100 and 80% < 130 mg/dl. 6,8% of patients met the combined ADA goal for BP, LDL and HbA1c. Concerning therapeutic regimens: 71,5% used oral hypoglycaemic agents (OAD) alone (52,1% of these were using 2 or more agents); 28,5% were treated with insulin (16,2% in combination with OAD). 52,1% of the patients were anti-aggregated with aspirin. CONCLUSIONS: The metabolic control (HbA1c) and LDL values were favourable in our patients sample, comparing to other studies. The percentage of patients treated to the recommended BP of 130/80 mmHg is consistent with the literature. Only 6,8% of patients met the combined ADA goal for BP, LDL and HbA1c. Despite our comparable results to published data, we would like to highlight the difficulty to accomplish international recommendations to metabolic and risk factors control in clinical practice and the necessity of an aggressive approach to diabetes treatment.

[Obesity and quality of life]. / Obesidade e qualidade de vida.

Obesity is considered one of the most relevant health problems of modern societies, as it constitutes a predominant risk factor in the development of various other diseases. The negative impact of obesity on the quality of life of individuals has been the subject of diverse research. The results of a test carried out at Gothenburg University in Sweden suggest that severe obesity is a debilitating factor both for health and psychosocial functioning. Research carried out in Madrid permitted identification of a profile of obese patients with impaired quality of life, which has enabled prophylactic intervention or early treatment of these cases to be considered. The results of a study carried out in the USA propose that pain would appear to be directly related with quality of life and could be considered a covariant of obesity, and should therefore be taken into account in obesity treatments. A study carried out in Oxford concluded that obese subjects or subjects with another chronic disease presented a deterioration in physical wellbeing, however only subjects with another chronic disease (without associated obesity) presented a deterioration in psychological wellbeing. The majority of studies suggest the negative influence of obesity and overweight on health and psychosocial functioning, however it is not possible to clearly define a linear relation between obesity and diminished quality of life.