J M González-Clemente1. 1. Unidad de Endocrinologia y Diabetes, Institut Català de la Salut, Barcelona.
Abstract
BACKGROUND: Most non-insulin dependent diabetes mellitus (NIDDM) care is provided at the primary care level. The aim of this study was to evaluate the recommendations of the European NIDDM Policy Group (ENPG) in a primary care setting in an urban area. PATIENTS AND METHODS: During 1994 clinical information concerning a group of patients attended in the primary care setting of an area of Barcelona city was recorded prospectively on a computerised information sheet. RESULTS: 483 patients were evaluated (age: 68.9 +/- 0.5 years; males: 43.3%; 13.1 +/- 0.4 years of NIDDM evolution), 303 treated without insulin and 180 with insulin. A 37.9% of patients never had carried out self-glucose monitoring and the patients with insulin practised it more frequently (p = 0.03). Levels of basal glycemia, HbA1c' total and HDL cholesterol, basal triglycerides and body mass index were poor in 65.8%, 57.3%, 25.2%, 48.2%, 20.7% and 59.6% of the patients, respectively. Retinopathy and microalbuminuria have never been screened in 32.9% and 95.4% of the patients, respectively: in both cases the situation was worst in those without insulin (p = 0.00 and p = 0.02, respectively). Amaurosis was present in 3.9% of patients, clinical neuropathy in 16.8%, clinical peripheral neuropathy in 19.0%, ischemic heart disease in 13.3%, lower limb amputations in 2.1% and a stroke history in 10.1%. All these complications and the level of HbA1c were higher in patients with insulin (p < 0.05). CONCLUSIONS: The attainment of the recommendations of ENPG is scarce at the primary care level. Patients had insufficient blood glucose self-monitoring, metabolic control and screening for retinopathy and microalbuminuria.
BACKGROUND: Most non-insulin dependent diabetes mellitus (NIDDM) care is provided at the primary care level. The aim of this study was to evaluate the recommendations of the European NIDDM Policy Group (ENPG) in a primary care setting in an urban area. PATIENTS AND METHODS: During 1994 clinical information concerning a group of patients attended in the primary care setting of an area of Barcelona city was recorded prospectively on a computerised information sheet. RESULTS: 483 patients were evaluated (age: 68.9 +/- 0.5 years; males: 43.3%; 13.1 +/- 0.4 years of NIDDM evolution), 303 treated without insulin and 180 with insulin. A 37.9% of patients never had carried out self-glucose monitoring and the patients with insulin practised it more frequently (p = 0.03). Levels of basal glycemia, HbA1c' total and HDL cholesterol, basal triglycerides and body mass index were poor in 65.8%, 57.3%, 25.2%, 48.2%, 20.7% and 59.6% of the patients, respectively. Retinopathy and microalbuminuria have never been screened in 32.9% and 95.4% of the patients, respectively: in both cases the situation was worst in those without insulin (p = 0.00 and p = 0.02, respectively). Amaurosis was present in 3.9% of patients, clinical neuropathy in 16.8%, clinical peripheral neuropathy in 19.0%, ischemic heart disease in 13.3%, lower limb amputations in 2.1% and a stroke history in 10.1%. All these complications and the level of HbA1c were higher in patients with insulin (p < 0.05). CONCLUSIONS: The attainment of the recommendations of ENPG is scarce at the primary care level. Patients had insufficient blood glucose self-monitoring, metabolic control and screening for retinopathy and microalbuminuria.
Authors: María José Sender Palacios; María Vernet Vernet; Miguel Maseras Bové; Antoni Salvador Playà; Laia Pascual Batlle; Juan Carlos Ondategui Parra; Esther Jovell Fernández Journal: Aten Primaria Date: 2010-04-07 Impact factor: 1.137