Análisis comparativo del manejo y control de un grupo de pacientes diabéticos frente a las guías de referencia

Abstract

Objective: To perform a comparative analysis of the management and control of a group of patients with diabetes mellitus type 2, belonging to a promotion and prevention program in Bogotá, regarding the program management guide and recommendations documented by other societies at the national and international level. Materials and Methods: A descriptive cross-sectional study was conducted from the medical history of patients. It was determined whether the evaluated parameters to control their disease were the necessary ones and were being applied correctly. Results: The 412 resolution documents, the ALAD guide (2013), the PAHO guide (2013), the ADA (2014) Guide and the IDF (2006) guide were analyzed. Then, 274 histories were reviewed, analyzing the hysical examination parameters, paraclinicals and other variables (cardiovascular risk, self-care, knowledge of the disease, psychological state). It was evidenced that the control of the physical exam aspects that mark the progression of the illness and the microvasculature damage are overlooked as well as the behavioral, cultural and informative character interventions (promotion of healthy lifestyles, learning of self-care measures, phychological stability). Differences in control values of praclinicals in the revised guides have been also observed. Conclusion: Variation in evaluation parameters, follow up and disease control in each guide have been observed, taking into account the different populations and being necessary that the guides are adapted considering the characteristics of Colombian people as far as their epidemiological profiles and health determinants.

Keywords:

Diabetes Mellitus Tipo 2

prevención y control

complicaciones de la diabetes

guía de práctica clínica

Diabetes Mellitus Type 2

prevention and control

diabetes complications

clinical practice guideline

Diabetes Mellitus Tipo 2

prevenção e controle

complicações da diabetes

guia de prática clínica

References

1. Danaei G, Finucane M, Lu Y, Singh G, Cowan M, Paciorek C et al. National, regional and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet. 2011; 378(9785): 31-40.

2. Mathers C, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLos Med. 2006; 3(11): e442.

3. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2014; 37(Suppl 1).

4. Ministerio de la Protección Social. Guía de Atención de la Diabetes Mellitus Tipo 2. Min. Prot. Social. 2007; 17: 361-440.

5. Morrison F, Goldberg S, Shubina M, Turchin A. Performance of Primary Care Physicians and Other Providers on Key Process Measures in the Treatment of Diabetes. Diabetes Care. 2013; 36(5): 1147-52.

6. Klein H, Jackson S, Street K, Whitacre J, Klein G. Diabetes self-management education: miles to go. Nurs Res Pract. 2013; 2013(2013): 1-15.

7. Toussi M, Lamy J, Le Toumelin P, Venot A. Using data mining techniques to explore physicians' therapeutic decisions when clinical guidelines do not provide recommendations: methods and example for type 2 diabetes. BMC Med Inform Decis Mak. 2009; 9(28): 1-12.

8. Cuenta de Alto Costo - Fondo Colombiano de Enfermedades de Alto Costo. Situación de la enfermedad renal crónica en Colombia 2009; 2010.

9. Médicos Asociados. Guía de Atención de la Diabetes Mellitus Tipo 2. 2007; 1: 1-16.

10. Asociación Latinoamericana de Diabetes. Guías ALAD sobre el Diagnóstico, Control y Tratamiento de la Diabetes Mellitus Tipo 2 con Medicina Basada en Evidencia; 2013.

11. OPS, Agencia Canadiense de Desarrollo Internacional. Manejo de la Diabetes en Atención Primaria en Salud. Protocolo 3, Guía 3, 2011: 1-20.

12. Federación Internacional de Diabetes. Clinical Guidelines Task Force, Guía global para la diabetes tipo 2; 2006.

13. Rodríguez M, García J, El Modelo psicológico de la salud y la diabetes. Revista Electrónica de Psicología Iztacala [Internet] 2011. [acceso 28 de febrero de 2014]; 14(2): 210-222. Disponible en: www.iztacala.unam.mx/carreras/psicologia/psiclin/

14. Khandeka R. Screening and Public Health Strategies for Diabetic Retinopathy in the Eastern Mediterranean Region. Middle East African Journal of Ophthalmology. 2012; 19(2): 178-84.

15. Neal R et al. The system of care for the diabetic foot: objectives, outcomes, and opportunities. Diabetic Foot & Ankle [Internet] 2013. [acceso abril de 2014]; 4: 21847. Disponible en: http://dx.doi.org/10.3402/dfa.v4i0.21847

16. Pinilla A, Sánchez A, Mejía A, Barrera M. Actividades de prevención del pie diabético en pacientes de consulta externa de primer nivel. Rev. salud pública. 2011; 13(2): 262-273.

17. Ferrer J et al. Perfil profesional del educador de pacientes con diabetes. Grupo de Trabajo Guías Clínicas y Consensos de la Sociedad Española de Diabetes. Av Diabetol. 2012; 28(2): 38-47.

18. Laura H, Sabrina T, Martin D. Effectiveness of group medical visits for improving diabetes care: a systematic review and meta-analysis. CMAJ. 2013; 185(13).

19. Carcavilla A. Atención al paciente con diabetes: algo más que insulina. Rev Pediatr Aten Primaria. 2009; 11(16): 217-238.

20. Rodríguez M, Rentería A, García J. Adherencia a la dieta en pacientes diabéticos: efectos de una intervención. SUMMA psicológica UST. 2013; 10(1): 91-101.

21. Renard L, Bocquet V, Vidal G et al. Adherence to international follow-up guidelines in type 2 diabetes: a longitudinal cohort study in luxembourg. PLoS One. 2013; 8(11): 1-42.

22. García N, López A, Núñez M, Meoro A, Sánchez C, Romero H et al. How to reduce avoidable admissions due to acute diabetes complications?: Interrelation between primary and specialized attention in a diabetes unit. Nutr. Hosp. 2012; 27(6): 2079-2088.

23. Hernández A, Guzmán S, Padilla G, Rosello M, Cartín F, Yung-Li G, et al. Evaluación de un programa educativo en diabetes para el nivel primario en salud. Rev. costarric. salud pública. 2008; 17(32): 10-16.

24. Smith-Palmer J, Brandle M, Trevisan R, Orsini M, Liabat S, Valentine W. Assessment of the association between glycemic variability and diabetes-related complications in type 1 and type 2 diabetes. Diabetes. Research and Clinical Practice. 2014; 105(3): 273-284.

25. Oude S. Guideline adherence and health outcomes in diabetes mellitus type 2 patients: across-sectional study. BMC Health Services Research [Internet] 2015. [acceso 22 de enero de 2015]; 15: 22. Disponible en: http://www.sciencedirect.com/science/article/pii/S1695403312003815

26. McGavock J, Dart A, Wicklow B. Lifestyle Therapy for the Treatment of Youth with Type 2 Diabetes. Current Diabetes Reports. 2015; 15: 568.

27. Maruthur N, Ma Y, Delahanty L et al. Early Response to Preventive Strategies in the Diabetes Prevention Program. Journal of General Internal Medicine. 2013; 28(12): 1629-1636.

28. Pantoja T, Soto M. Guías de práctica clínica: una introducción a su elaboración e implementación. Rev Med Chile. 2014; 142: 98-104.