Characteristics of patients with type 2 diabetes in México: Results from a large population-based nationwide survey.

OBJECTIVE: To describe the clinical characteristics of the diabetic population that formed part of a population-based survey conducted in México. RESEARCH DESIGN AND METHODS: In 2000, information was obtained from 42,886 subjects aged > or =20 years using a multistage sampling procedure. Standardized questionnaires were used. Anthropometric measurements, blood pressure, and capillary glucose concentrations were taken. RESULTS: Type 2 diabetes was found in 3,597 subjects (age-adjusted prevalence 8.18%), of which 2,878 (80%) had previously been diagnosed. The average age of the diabetic participants was 55.2 +/- 13.5 years; 13% were <40 years of age. Nine percent had been diagnosed for >10 years. The average BMI was 29.2 +/- 5.7 kg/m(2); three-quarters of the cases had BMI >25 kg/m(2). The average waist circumference was 102 +/- 13.4 cm, and increased waist circumference was more common among women. Arterial hypertension was found in half of the cases and, of those on treatment, only one-third had a blood pressure <140/90 mmHg. Smoking was reported in 34% of the diabetic group, a higher rate than in the nondiabetic subjects. There was at least one modifiable coronary risk factor in 67.6% of the cases. Very few followed an exercise or dietary regimen and a small percentage used insulin. CONCLUSIONS: Diabetes affects a large proportion of Mexican adults (8.18%). This figure may be underestimated. The majority of the subjects had modifiable risk factors for the chronic complications of diabetes. Only a few achieved adequate blood pressure control and other treatment goals.

[Mutual Help Groups: diabetes and hypertension control strategy]. / Grupos de Ayuda Mutua: estrategia para el control de diabetes e hipertensión arterial.

OBJECTIVE: To evaluate the accomplishment of the treatment basic goals of every person with diabetes type 2 that attend the Mutual Help Groups (GAM) of the Mexican Ministry of Health (SS). MATERIAL AND METHODS: This transversal comparative study was carried out in 15 Mexican states, through the accomplishment reports of the treatment basic goals of the GAM integrants by June of 2001, compared to the reported figures by the Health Information System for Open Population (SISPA), Ministry of Health on the same date. The studied variables are: age, sex, blood glucose, blood pressure, body mass index, physical activity and pharmacological treatment. RESULTS: The treatment basic goals accomplishment for 6, 958 people with diabetes was evaluated, all of them attended the Ministry of Health GAMs, in 15 of the 32 Mexican states including the Federal District. When comparing frequencies of patients with diabetes controlled by the GAM and the SISPA, a differential was appreciated, being observed a tendency that showed that people in the GAM were much more controlled; when analyzing with the test Student "t" the differences were even more significant (p < 0.005). The obese diabetics group had a higher risk of being uncontrolled, in relation to the group of non-obese diabetics (OR 1.8, CI: 1.06,1.32; p < 0.002). When comparing the sedentary to the non-sedentary group it was found that the sedentary diabetics presented 1.56 times higher risk of being uncontrolled, that those in the diabetes group that carried out physical activity (CI: 1.37,1.78; p < 0.001). CONCLUSIONS: The Mutual Help Groups are a fundamental strategy in the educational line for improving the disease control, since people with diabetes or hypertension and their relatives play an active role in treatment development accomplishment, as well as in the disease prevention and control. Unlike to that reported in the SISPA, the highest benefits of control, are achieved in people with diabetes or hypertension who attend the GAM.

Using collaborative learning to improve diabetes care and outcomes: the VIDA project.

UNLABELLED: The prevalence of diabetes in Mexico among those 20-64 years of age has increased from 7.2% in 1993 to 10.7% in 2000. National population-based surveys in Mexico demonstrated that 50% of the total population with diabetes had blood glucose levels of 200mg/dl or higher. Thus, diabetes care has become one of the most important public health challenges in this country. The aim of the study was to improve the quality of diabetes care in primary health care centers using the chronic care model and the breakthrough series (BTS) collaborative methodology. METHODS: Ten public health centers in the cities of Xalapa and Veracruz were randomly selected to participate in the project. Five of the health centers were randomly assigned to receive the intervention (intervention group) and the other five followed usual care (usual care group). The intervention was evaluated by A1c test before and after the intervention in both groups of patients. Patients were followed for 18 months from November 2002 to May 2004. Results were adjusted for the clustering of patients within practices and baseline measure. RESULTS: The proportion of people with good glycemic control (A1c<7%) among those in the intervention group increased from 28% before the intervention to 39% after the intervention. The proportion of patients achieving three or more quality improvement goals increased from 16.6% to 69.7% (p<0.001) among the intervention group while the usual care group experienced a non-significant decrease from 12.4% to 5.9% (p=0.118). The focus on the primary care team and the participation of people with diabetes were strategic elements incorporated into the methodology, expected to ensure sustainability of continued improvement of health outcomes. CONCLUSIONS: The intervention introduced modifications to solve problems identified by health teams in their practice and improved process and outcome measures of quality diabetes care. Most of the actions were directed at four components of the chronic care model: self-management support, decision support, delivery system design, and clinical information systems.

Hipertensión arterial en México: Resultados de la Encuesta Nacional de Salud (ENSA) 2000 / Arterial hypertension in Mexico: results of the National Health Survey 2000

AIMS: Hypertension remains as a major cause of cardiovascular morbidity in MÚxico. The Health National Survey 2000 of MÚxico was performed to analyze the current status of the prevalence of some risk factors such as diabetes, hypertension (HTA), obesity, smoking, and proteinuria. METHODS: A National Survey was carried out in MÚxico where 45,300 individuals between 20 to 69-y.o. were screened. The estimated sample size was calculated considering the total number of persons into the mentioned age; a minimal prevalence of 6 of the included risk factors, at a significance level of 0.05; a maximum relative error of 0.145, and a rate of response of at least 70. Diagnosis of HTA was accepted in: previous medical diagnosis with prescription of antihypertensive drugs, or high blood pressure (> or = 140/90 mmHg) detected during the interview. Data were adjusted for the national distribution of age-groups and gender (established in 2000, INEGI). RESULTS: 38,377 (98.8) individuals were correctly screened for blood pressure. The prevalence of hypertension in MÚxico was 30.05 (34.2 in men and 26.3 in women). The prevalence was directly related with age and gender. The percentage of mexicans with HTA after 50-y.o. is > 50. The prevalence was greater in women after 50-y.o. Among persons with hypertension, treatment was detected in 46 and approximately 20 of them were controlled (< 140/90 mmHg). The percentage of mexicans with HTA who were unaware that they have high blood pressure was 61. The total percentage of HTA controlled was 14.6. The North states had the greater prevalence (approximately 34) of HTA while South states had the lower prevalence (27). The odds ratio (age/sex-adjusted) for HTA were: for diabetes 1.54(CI95, 1.44-1.63); for obesity 2.3 (CI 95, 2.22-2.43); for smoking 1.26 (CI 95, 1.21-1.32). For proteinuria subjects, 40 had HTA. CONCLUSIONS: Around 15 millions of mexicans between 20 to 69-y.o. had hypertension, 60 of them are unaware. The prevalence of hypertension in MÚxico (30.05) has increased. Among persons with hypertension -15 are controlled. The North of MÚxico has the higher prevalence of hypertension. Diabetes, smoking, and obesity increase the risk of hypertension. The 2000 National Survey of Health shows the epidemiological trend in several important chronic diseases in MÚxico and declare an urgent need of new strategies for detection, control and treatment of hypertension.