Faculty of Health, Universidad Tecnológica de Pereira, Pereira, Colombia.
Rev Panam Salud Publica. 2009 Dec;26(6):529-35. doi: 10.1590/s1020-49892009001200008.
To assess quality and effectiveness of diabetes care in a sample of Colombian diabetes patients treated by the national social security health system (SGSSS).
A retrospective study was conducted among 19 704 type 2 diabetes patients >30 years old who were SGSSS members, on pharmacological therapy, and treated at least twice by the SGSSS diabetes control program in one of nine cities from 1 July 2006 to 30 June 2007. A random sample of 406 was obtained. Using subjects' clinical history, the following factors were assessed: use of antidiabetic drugs and prescribed daily doses; use of antithrombotic therapies; additional medications; level and control of glycosylated hemoglobin (HbA1c), blood pressure, and cholesterol; urine albumin level; retinal and foot condition; and changes in medical regimens at most recent clinic visit.
Annual risk factor testing rates were high (81.5%, HbA1c; 100%, blood pressure; 76.8%, total cholesterol), and a large proportion of patients were at target levels for HbA1c (42.9% < or = 7.0%), blood pressure (66.2% <130/80 mmHg), and serum lipids (44.9% total cholesterol <200 mg/dL). However, only 6.9% were within recommended levels for all three risk factors. At most recent clinic visit, pharmaceutical regimens were adjusted for 39.7%, 58.2%, and 42.5% of patients above HbA1c, blood pressure, and cholesterol target levels, respectively.
Despite high testing rates, metabolic control was not effective. Low rates of medication adjustment among patients with measures outside target ranges suggest the need for changes in routine diabetes care to ensure therapeutic regimens are adjusted appropriately.
评估在接受国家社会保障健康系统（SGSSS）治疗的哥伦比亚糖尿病患者样本中糖尿病护理的质量和效果。
对 19704 名年龄>30 岁的 2 型糖尿病患者进行了回顾性研究，这些患者是 SGSSS 的成员，正在接受药物治疗，并且在 2006 年 7 月 1 日至 2007 年 6 月 30 日期间在九个城市中的至少两个城市通过 SGSSS 糖尿病控制计划接受了至少两次治疗。随机抽取了 406 名患者。使用患者的临床病史评估了以下因素：使用抗糖尿病药物和规定的日剂量；使用抗血栓疗法；其他药物；糖化血红蛋白（HbA1c）、血压和胆固醇的水平和控制情况；尿白蛋白水平；视网膜和足部状况；以及最近就诊时的医疗方案变化。
危险因素年度检测率较高（HbA1c：81.5%；血压：100%；总胆固醇：76.8%），且很大比例的患者 HbA1c（42.9%<或=7.0%）、血压（66.2%<130/80mmHg）和血清脂质（44.9%总胆固醇<200mg/dL）达到目标水平。但是，仅有 6.9%的患者同时达到三个危险因素的建议水平。在最近的就诊时，调整了 39.7%、58.2%和 42.5%的患者的药物治疗方案，使其 HbA1c、血压和胆固醇分别高于目标水平。
尽管检测率较高，但代谢控制效果不佳。在超出目标范围的患者中，调整药物治疗的比例较低，这表明需要改变常规的糖尿病护理，以确保适当调整治疗方案。
