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.
Subject(s)
Diabetes Mellitus, Type 1 , Blood Glucose , Blood Glucose Self-Monitoring , Delivery of Health Care , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/drug therapy , Diabetes Mellitus, Type 1/epidemiology , Glycated Hemoglobin/analysis , Glycemic Control , Humans , Mexico/epidemiologyABSTRACT
Background: Information regarding diagnosis, treatment, and follow-up of patients with type 1 diabetes (PWT1D) in Mexico is limited. We developed an on-line platform Registro Nacional de Pacientes con Diabetes Tipo 1 (RENACED-DT1). Objective: The objective of the study was to describe the characteristics and healthcare of PWT1D registered in RENACED-DT1. Methods: Analyses of 965 PWT1D from July 2014 to January 2018 in different endocrinology clinics around Mexico. Results: Sixty-one percent were female with median age of 21 years, age at diagnosis 11 years, and disease duration at inclusion 8.2 years. Treatment regimen was basal-bolus in 61% and insulin-pumps in 21% (mainly in the private sector); 33.3% with self-monitoring of blood-glucose (SMBG) ≥4 times/day. Mean HbA1c at last follow-up was 8.7 ± 2.1% (72±23 mmol/mol), 18% had HbA1c < 7% (53 mmol/mol), and 35% > 9% (75 mmol/mol). SMBG ≥ 4 times/day was associated with HbA1c < 7%. Time since diagnosis > 10 years, female sex, BMI ≥ 30 kg/m2, SMBG < 4 times/day, and any hypoglycemia were associated with microvascular complications (p < 0.05). Conclusions: Percentage of patients achieving HbA1c < 7% is low; increased blood glucose monitoring is associated with better glycemic control. The achievement of optimal glycemic control must be increased to reduce the incidence of chronic complications and improve quality of life in PWT1D.
Subject(s)
Humans , Male , Female , Child , Adolescent , Young Adult , Diabetes Mellitus, Type 1/therapy , Diabetes Mellitus, Type 1/epidemiology , Quality of Life , Blood Glucose , Glycated Hemoglobin/analysis , Blood Glucose Self-Monitoring , Registries , Hypoglycemic Agents , Insulin , Mexico/epidemiologyABSTRACT
BACKGROUND: Information regarding diagnosis, treatment, and follow-up of patients with type 1 diabetes (PWT1D) in Mexico is limited. We developed an on-line platform Registro Nacional de Pacientes con Diabetes Tipo 1 (RENACED-DT1). OBJECTIVE: The objective of the study was to describe the characteristics and healthcare of PWT1D registered in RENACED-DT1. METHODS: Analyses of 965 PWT1D from July 2014 to January 2018 in different endocrinology clinics around Mexico. RESULTS: Sixty-one percent were female with median age of 21 years, age at diagnosis 11 years, and disease duration at inclusion 8.2 years. Treatment regimen was basal-bolus in 61% and insulin-pumps in 21% (mainly in the private sector); 33.3% with self-monitoring of blood-glucose (SMBG) ≥4 times/day. Mean HbA1c at last follow-up was 8.7 ± 2.1% (72±23 mmol/mol), 18% had HbA1c < 7% (53 mmol/mol), and 35% > 9% (75 mmol/mol). SMBG ≥ 4 times/day was associated with HbA1c < 7%. Time since diagnosis > 10 years, female sex, BMI ≥ 30 kg/m2, SMBG < 4 times/day, and any hypoglycemia were associated with microvascular complications (p < 0.05). CONCLUSIONS: Percentage of patients achieving HbA1c < 7% is low; increased blood glucose monitoring is associated with better glycemic control. The achievement of optimal glycemic control must be increased to reduce the incidence of chronic complications and improve quality of life in PWT1D.
Subject(s)
Diabetes Mellitus, Type 1 , Adolescent , Blood Glucose , Blood Glucose Self-Monitoring , Child , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 1/therapy , Female , Glycated Hemoglobin/analysis , Humans , Hypoglycemic Agents , Insulin , Male , Mexico/epidemiology , Quality of Life , Registries , Young AdultABSTRACT
BACKGROUND: currently, there is an increase in the incidence of obesity in the pediatric population, which is associated with an increase in metabolic syndrome (MetS). Thus, an early diagnosis of MetS is needed in this population to improve the prevention of cardiovascular disease and type 2 diabetes in adulthood. OBJECTIVE: the aim of this study was to explore the ability of health professionals to identify the main criteria for MetS in children, which is required for establishing the conditions for early diagnosis and timely treatment. METHODS: a cross-sectional study was conducted using a survey and conducted in two states of the republic (Aguascalientes and Hidalgo) and in the Federal District from January to December 2014. RESULTS: the questionnaire was applied to 274 health professionals. Most of these professionals (61.7%) reported knowledge of the criteria for MetS diagnosis in children and adolescents. Additionally, it was observed that 63.1% of professionals did not perform the needed measurements the waist of circumference in preschool children and that 46.4% did not measure them in school children. However, 64.6% of professionals performed the measurements in adolescents. CONCLUSIONS: this study found that health professionals providing care to pediatric patients do not know the parameters and cutoff points for MetS diagnosis. They do not conduct a deliberate search for MetS risk factors, which is a major limitation for diagnosis and early treatment. Therefore, we suggest a systematic approach for maintaining the standards of health professionals and to make determining the criteria for proper diagnosis of MetS a target of clinical practice.
Introducción: actualmente se ha producido un aumento en la incidencia de obesidad en la población pediátrica, y con ello un incremento del Síndrome Metabólico (SM) por lo que es necesario realizar un diagnóstico oportuno del SM en esta población, así se propiciará la prevención de la enfermedad cardiovascular y la diabetes tipo 2 en la edad adulta. Objetivo: explorar la capacidad de los profesionales de la salud para identificar los principales criterios de SM en niños, requisito para poder establecer las condiciones para el diagnóstico temprano y su tratamiento oportuno. Material y métodos: se realizó un estudio transversal de investigación a través de una encuesta para identificar el conocimiento y la capacidad técnica de los profesionales de la salud en la atención y detección de niños y adolescentes con SM. Se llevó a cabo en dos Estados de la República (Aguascalientes e Hidalgo) y en el Distrito Federal en los meses de enero a diciembre de 2014. Resultados: el cuestionario se aplicó a 274 profesionales de la salud dentro de los cuales se encontraban licenciados en nutrición, médicos generalistas, médicos pediatras, licenciados en enfermería y licenciados en enfermería con especialidad pediátrica. El 61,7% de los encuestados refirieron conocer los criterios de diagnóstico de SM en esta población, sin embargo solo el 32,8% contestó de manera correcta a estos. Por otro lado se observó que el 63,1% del total de los profesionales no miden la circunferencia de cintura en preescolares y el 46,4% en escolares; no obstante, el 64,6% sí realiza esta medición en adolescentes. Por otro lado, el 72,6% de los encuestados no mide la presión arterial en edad preescolar y el 64,6% en edad escolar; sin embargo, el 52,2% sí la mide en adolescentes. Conclusión: en el estudio observamos que los profesionales de la salud que dan atención a los pacientes pediátricos no conocen los parámetros y puntos de corte para diagnosticar el SM; no realizan una búsqueda intencionada de esos factores de riesgo y, por lo tanto, esto se considera una gran limitación para realizar el diagnóstico y tratamiento temprano. Por lo que sugerimos un acercamiento sistemático para mantener los estándares de los profesionales de la salud y establecer como objetivo de la práctica el determinar los criterios de SM para realizar el diagnóstico adecuadamente.
Subject(s)
Metabolic Syndrome/diagnosis , Personnel, Hospital , Adolescent , Child , Child, Preschool , Clinical Competence , Cross-Sectional Studies , Early Diagnosis , Female , Health Care Surveys , Health Knowledge, Attitudes, Practice , Humans , Male , Mexico , Nurses , Physicians , Risk Factors , Surveys and QuestionnairesABSTRACT
Background: currently, there is an increase in the incidence of obesity in the pediatric population, which is associated with an increase in metabolic syndrome (MetS). Thus, an early diagnosis of MetS is needed in this population to improve the prevention of cardiovascular disease and type 2 diabetes in adulthood. Objective: the aim of this study was to explore the ability of health professionals to identify the main criteria for MetS in children, which is required for establishing the conditions for early diagnosis and timely treatment. Methods: a cross-sectional study was conducted using a survey and conducted in two states of the republic (Aguascalientes and Hidalgo) and in the Federal District from January to December 2014. Results: the questionnaire was applied to 274 health professionals. Most of these professionals (61.7%) reported knowledge of the criteria for MetS diagnosis in children and adolescents. Additionally, it was observed that 63.1% of professionals did not perform the needed measurements the waist of circumference in preschool children and that 46.4% did not measure them in school children. However, 64.6% of professionals performed the measurements in adolescents. Conclusions: this study found that health professionals providing care to pediatric patients do not know the parameters and cutoff points for MetS diagnosis. They do not conduct a deliberate search for MetS risk factors, which is a major limitation for diagnosis and early treatment. Therefore, we suggest a systematic approach for maintaining the standards of health professionals and to make determining the criteria for proper diagnosis of MetS a target of clinical practice (AU)
Introducción: actualmente se ha producido un aumento en la incidencia de obesidad en la población pediátrica, y con ello un incremento del Síndrome Metabólico (SM) por lo que es necesario realizar un diagnóstico oportuno del SM en esta población, así se propiciará la prevención de la enfermedad cardiovascular y la diabetes tipo 2 en la edad adulta. Objetivo: explorar la capacidad de los profesionales de la salud para identificar los principales criterios de SM en niños, requisito para poder establecer las condiciones para el diagnóstico temprano y su tratamiento oportuno. Material y métodos: se realizó un estudio transversal de investigación a través de una encuesta para identificar el conocimiento y la capacidad técnica de los profesionales de la salud en la atención y detección de niños y adolescentes con SM. Se llevó a cabo en dos Estados de la República (Aguascalientes e Hidalgo) y en el Distrito Federal en los meses de enero a diciembre de 2014. Resultados: el cuestionario se aplicó a 274 profesionales de la salud dentro de los cuales se encontraban licenciados en nutrición, médicos generalistas, médicos pediatras, licenciados en enfermería y licenciados en enfermería con especialidad pediátrica. El 61,7% de los encuestados refirieron conocer los criterios de diagnóstico de SM en esta población, sin embargo solo el 32,8% contestó de manera correcta a estos. Por otro lado se observó que el 63,1% del total de los profesionales no miden la circunferencia de cintura en preescolares y el 46,4% en escolares; no obstante, el 64,6% sí realiza esta medición en adolescentes. Por otro lado, el 72,6% de los encuestados no mide la presión arterial en edad preescolar y el 64,6% en edad escolar; sin embargo, el 52,2% sí la mide en adolescentes. Conclusión: en el estudio observamos que los profesionales de la salud que dan atención a los pacientes pediátricos no conocen los parámetros y puntos de corte para diagnosticar el SM; no realizan una búsqueda intencionada de esos factores de riesgo y, por lo tanto, esto se considera una gran limitación para realizar el diagnóstico y tratamiento temprano. Por lo que sugerimos un acercamiento sistemático para mantener los estándares de los profesionales de la salud y establecer como objetivo de la práctica el determinar los criterios de SM para realizar el diagnóstico adecuadamente (AU)
Subject(s)
Child , Humans , Metabolic Syndrome/diagnosis , Nutrition Programs/organization & administration , Food and Nutritional Surveillance , Nutrition Assessment , Quality of Health Care/statistics & numerical data , Quality Indicators, Health Care/statistics & numerical data , Professional Competence/statistics & numerical dataABSTRACT
AIM: To appraise the economic burden for families of patients with type 1 diabetes mellitus (DM1) at the Instituto Nacional de Pediatria in Mexico City. PATIENTS AND METHODS: DM1 family direct costs were obtained from a standardized economic survey in 59 children with no chronic severe complications such as kidney failure in 2002-3. RESULTS: Mean family annual direct cost of treatment and monitoring was US $1689.87 which includes government funding given to both outpatients and inpatients. Despite this, DM1 out-of-pocket cost for families is very high compared to the minimum official wage of approximately $4.00 dollar/day versus $4.06 cost DM1/day. No correlation between parents' age, education or socio-economic level and direct cost was statistically significant. CONCLUSIONS: The highest economic burden was due to self-monitoring of blood glucose (SMBG) 53.0% and insulin 14.8%. The costs were higher in children with poor metabolic control who performed SMBG less often.
