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OBJECTIVE: The objective of this study was to assess the current relationship between certain demographics and chemical factors, and the risk of cardiovascular complications, within a Puerto Rican population with diabetes mellitus. RESEARCH DESIGN AND METHODS: A total of 2075 patients with diabetes mellitus were retrospectively evaluated to determine the influence of certain demographics and chemical variables on the appearance of cardiovascular complications. A group of demographic and laboratory variables were analyzed. Our sample was obtained, based on convenience, from an endocrinologist's office in an area of about 250â 000 people. All the patients met the American Diabetes Association (ADA) definitions for diabetes mellitus. The study covered a time period of 8â years. The patients signed an informed consent document at their first office visit. Data were obtained by the endocrinologist in charge. RESULTS: We considered the demographic variables of sex, age, time with diabetes, lipid profile, metabolic control (measured with glycated hemoglobin levels), and microalbumin renal excretion. Cardiovascular complications were more prevalent in patients with poor metabolic control, those with prolonged disease duration, men, and patients who were more than 50â years of age. We found no relationship between cardiovascular disease, systolic blood pressure over 130â mmâ Hg, body mass index and low-density lipoprotein cholesterol levels over 100â mg/dL. CONCLUSIONS: In Puerto Rican patients with diabetes mellitus, there is a statistically significant relationship between patient's gender, age, disease duration, glycemic control and increased kidney microalbumin excretion with cardiovascular complications.
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BACKGROUND: Among patients with type 2 diabetes, insulin intensification to achieve glycemic targets occurs less often than clinically indicated. Barriers to intensification are not well understood. We present patients' baseline characteristics from MOSAIc, a study investigating patient-, physician-, and healthcare environment-based factors affecting insulin intensification and subsequent health outcomes. METHODS: MOSAIc is a longitudinal, observational study following patients' diabetes care in 18 countries: United Arab Emirates (UAE), Argentina, Brazil, Canada, China, Germany, India, Israel, Italy, Japan, Mexico, Russia, Saudi Arabia, South Korea, Spain, Turkey, United Kingdom, United States. Eligible patients are age ≥ 18, have type 2 diabetes, and have used insulin for ≥ 3 months with/without other antidiabetic medications. Extensive baseline demographic, clinical, and psychosocial data are collected at baseline and regular intervals during the 24-month follow-up. We conducted descriptive analyses of baseline data. RESULTS: Four thousand three hundred forty one patients met eligibility criteria. Patients received their type 2 diabetes diagnosis 12 ± 8 years prior to baseline visit, yet patients in developing countries were younger than in developed countries (e.g., UAE, 55 ± 10; Germany = 70 ± 10). Saudi Arabians had the highest HbA1c values (9.0 ± 2.2) and Germany (7.5 ± 1.4) among the lowest. Most patients in 5 (28%) of the 18 countries did not use an oral antidiabetic drug. Over half of patients in fourteen (78 %) countries exclusively used basal insulin; most Indian and Chinese patients exclusively used mixed insulin. CONCLUSIONS: MOSAIc's baseline data highlight differences in patient characteristics across countries. These patterns, along with physician and healthcare environment differences, may contribute to the likelihood of insulin intensification and subsequent clinical outcomes.
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Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Brasil/epidemiologia , Canadá/epidemiologia , China/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/metabolismo , Progressão da Doença , Quimioterapia Combinada , Feminino , Alemanha/epidemiologia , Hemoglobinas Glicadas/metabolismo , Humanos , Índia/epidemiologia , Israel/epidemiologia , Itália/epidemiologia , Japão/epidemiologia , Estudos Longitudinais , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Estudos Prospectivos , República da Coreia/epidemiologia , Federação Russa/epidemiologia , Arábia Saudita/epidemiologia , Espanha/epidemiologia , Turquia/epidemiologia , Emirados Árabes Unidos/epidemiologia , Reino Unido/epidemiologia , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: To analyze glycemic control among patients with diabetes mellitus (DM) in Puerto Rico (PR) using the 2011 American Diabetes Association (ADA) recommendations and glycemic goals as standards. We also explored other factors that are related to glycemic control. METHODS: Glycemic data were obtained from 600 adults with DM from 5 different regions in PR. The patient's health insurance coverage, type of health care provider, type of diabetes treatment, gender, age, physical activity, weight, degree of hypertension and degree and type of dyslipidemia comorbidities (when one or both were applicable), and disease duration were variables of interest. Univariate and bivariate analyses were conducted to describe the population and determine the statistical differences in the glycemic control of the subjects. RESULTS: Fewer than half of the participants achieved the ADA-recommended levels for HbA1c (37.3%) and blood pressure (34%). However, relatively more participants met the goals for high-density lipoprotein cholesterol (51.7%), low-density lipoprotein cholesterol (59.9%), and triglycerides (61.5%). The percentage of participants reaching the HbA1c, blood pressure, and low-density lipoprotein cholesterol goals at the same time was 9.9%. Patients with private health insurance achieved better glycemic control than did patients in the public-managed healthcare system. Half of the population presented simultaneous hypertension, dyslipidemia, and DM comorbidities. Only 50% of the participants were physically active. CONCLUSION: In the sample population, glycemic control levels and blood pressure levels in adults with DM were far from the ADA-recommended standards. Physical activity levels, type of medical insurance, and type of DM medical treatment were the main modifiable factors associated with the goal of attaining glycemic control. Barriers that limit the achievement of this goal should be analyzed in more detail to improve the medical care for people with DM.
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Diabetes Mellitus/sangue , Dislipidemias/sangue , Hemoglobinas Glicadas/análise , Hipertensão/sangue , Lipídeos/sangue , Adolescente , Adulto , Idoso , Pressão Sanguínea , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Comorbidade , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/epidemiologia , Dislipidemias/tratamento farmacológico , Dislipidemias/epidemiologia , Feminino , Objetivos , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Seguro Saúde , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Porto Rico/epidemiologia , Resultado do Tratamento , Triglicerídeos/sangue , Estados Unidos , Instituições Filantrópicas de Saúde , Adulto JovemRESUMO
OBJECTIVE: To evaluate and compare the quality of diabetes care in a large managed care system and fee-for-service payment system in Puerto Rico. METHODS: This retrospective cross-sectional study assessed the adherence to standards of diabetes care in 1,687,202 subjects--226,210 from a fee-for-service population and 1,460,992 from a managed care group. Patients with diabetes mellitus were identified from insurance claims reports. Type of health-care provider, service location, number of visits, and laboratory utilization were also assessed. RESULTS: From the analysis, we identified 90,616 patients with diabetes (5.4% of the overall study group). Of these, 66,587 (73.5%) were found to have at least one encounter with a physician in a medical visit. Of the 66,586 patients with diabetes who visited a physician, only 4% were treated by an endocrinologist. General laboratory utilization was 34% for the entire population of patients with diabetes studied. In the group of patients with documented laboratory tests, 93% had a documented fasting blood glucose test; in contrast, hemoglobin A lc testing was performed in only 9% of the patients. The fee-for-service group had a higher rate of visits to medical specialists and general laboratory utilization, whereas the managed care group had a higher rate of hospital admissions and emergency department visits. CONCLUSION: The quality of diabetes management and the subsequent outcomes are related to patient and health-care provider adherence to standards of care. In this analysis, we found that patients and physicians are responsible for low compliance with recognized standards of diabetes care in Puerto Rico. The lack of adequate management will lead to increased mortality, development and severity of chronic complications, and increased emergency department utilization. Therefore, health-care providers and payers should find ways to achieve more effective promotion of adherence to accepted standards of care for patients with diabetes.