Endocrinology Service, Hospital Nacional Arzobispo Loayza, Ministerio de Salud, Lima, Peru; School of Medicine, Universidad Nacional Mayor de San Marcos, Lima Peru.
CRONICAS Center of Excellence in Chronic Disease, Universidad Peruana Cayetano Heredia, Lima, Peru.
Prim Care Diabetes. 2021 Jun;15(3):488-494. doi: 10.1016/j.pcd.2020.11.014. Epub 2020 Dec 24.
To characterize diabetes care across healthcare facilities in six Peruvian regions.
Cross-sectional study of patients with type 2 diabetes mellitus (T2DM), ranging from primary care facilities to hospital-based facilities, in six Peruvian regions. Data was collected by health staff trained between 2012 and 2016. We studied six diabetes care outcomes and four adequate diabetes care outcomes considering the healthcare facility as the exposure of interest. We estimated prevalence ratios (PR) and their 95% confidence intervals (95% CI) using Poisson regression with robust variance.
Data from 8879 patients with T2DM, mean age 59.1 years (SD ± 12.2), 53.6% males, was analyzed. Of these, 8096 (91.2%) were treated at primary care facilities. The proportions of patients who had HbA1c, LDL-c, and creatinine/microalbumin test performed increased with the setting of the healthcare facility. Overall, 39%-56% of patients had an adequate HbA1c control, being higher in hospital-based facilities with specialists in comparison to primary care facilities.
We observed that the higher the setting of the facility, the higher the rate of the assessed diabetes care outcomes and adequate diabetes care for four of the six targets (fasting glucose, HbA1c, LDL-c and creatinine or microalbumin) and for three of the four targets (glucose≤130 mg/dL, HbA1c ≤7%(53 mmol/mol) and LDL-c <100 mg/dL), respectively. Substantial gaps were observed at the primary care facilities, calling for the strengthening of diabetes care.
描述秘鲁六个地区的医疗机构中糖尿病护理的情况。
对秘鲁六个地区的 2 型糖尿病（T2DM）患者进行了一项横断面研究，这些患者的医疗服务范围从基层医疗机构到医院。数据由 2012 年至 2016 年间接受过培训的卫生人员收集。我们研究了六种糖尿病护理结果和四种适当的糖尿病护理结果，将医疗机构作为感兴趣的暴露因素。我们使用具有稳健方差的泊松回归估计了患病率比（PR）及其 95％置信区间（95％CI）。
共分析了来自 8879 名 T2DM 患者的数据，平均年龄为 59.1 岁（SD±12.2），男性占 53.6％。其中，8096 名（91.2％）在基层医疗机构接受治疗。HbA1c、LDL-c 和肌酐/微量白蛋白检测的患者比例随医疗机构的设置而增加。总体而言，39％-56％的患者HbA1c 控制达标，在设有专科医生的医院基础医疗机构中更高。
我们发现，医疗机构的级别越高，评估的糖尿病护理结果和四项达标率（空腹血糖、HbA1c、LDL-c 和肌酐或微量白蛋白）越高，而四项达标率（血糖≤130mg/dL、HbA1c≤7%（53mmol/mol）和 LDL-c<100mg/dL）中有三项越高。在基层医疗机构中仍存在很大差距，需要加强糖尿病护理。
