[Controlling diabetes mellitus and its complications in Medellín, Colombia, 2001-2003].

OBJECTIVES

To identify the principal sociodemographic, clinical, and behavioral characteristics of patients participating in diabetic care programs in the city of Medellín, Colombia, and to evaluate progress toward the goal of metabolic control and diabetic care standards.

METHODS

A cross-sectional, descriptive study was done, analyzing the clinical records of patients who had been participating for at least 6 months in the diabetic care programs of nine health care centers in Medellín. The study period ran from January 2001 to December 2003. The following data were collected: sociodemographic (age and sex), clinical (time since disease onset, diabetes type and treatment, and concurrent illnesses and their treatment), lifestyle habits (exercise routine, smoking, and sugar and fat consumption), chronic complications, and laboratory test results from the prior year. Questionable or missing data were categorized as unavailable.

RESULTS

Of the 3 583 clinical histories evaluated, we were able to confirm the form of diabetes for 3 554 patients. Of those 3 554, 95.1% had type 2 diabetes. Overall, 56.9% (95% confidence interval (95% CI): 55.2% to 58.6%) of the patients exercised regularly, 15.1% (95% CI: 13.9% to 16.3%) were current smokers, 17.7% (95% CI: 16.4% to 19.0%) were former smokers, and 67.2% (95% CI: 65.6% to 68.8%) had never smoked. In all, 21.0% (95% CI: 19.6% to 22.5%) of the patients consumed sugar regularly, while 24.8% (95% CI: 23.3% to 26.3%) consumed fats and only 19.5% (95% CI: 17.8% to 21.3%) were self-monitoring their glucose levels at least weekly. Among the type 2 diabetics, 68.8% had high blood pressure, and 98.2% had dyslipidemia. The average body mass index was 28.0 kg/m(2) (95% CI: 27.8 to 28.2). The average number of medications that the patients were taking to treat type 2 diabetes was 1.3; to treat high blood pressure, 1.9; and to treat dyslipidemia, 0.6. There were no data on low-density lipoprotein (LDL) cholesterol in 44.8% of the clinical records, and no data on high-density lipoprotein (HDL) cholesterol in 16.4% of the records. Among the complications, the most common were ocular ones (31.8%; 95% CI: 30.1% to 33.5%), followed by renal ones (25.9%; 95% CI: 24.4% to 27.5%), and cardiovascular ones (22.5%; 95% CI: 21.1% to 23.8%). Cholesterol control achievement was inadequate for LDL (reached by only 14.2% of the patients), for triglycerides (36.9% of patients), and HDL (47.4% of patients).

CONCLUSIONS

Among the study population in Medellín, the three chronic complications with the greatest impact on prognosis and health care costs of the diabetics were nephropathy, retinopathy, and dyslipidemia. The noticeable amount of unavailable data in the clinical records could be greatly reduced by standardizing the clinical record forms and by periodic quality checks of the records themselves.