González-Clemente J M
Unidad de Endocrinologia y Diabetes, Institut Català de la Salut, Barcelona.
Med Clin (Barc). 1997 Jan 25;108(3):91-7.
Most non-insulin dependent diabetes mellitus (NIDDM) care is provided at the primary care level. The aim of this study was to evaluate the recommendations of the European NIDDM Policy Group (ENPG) in a primary care setting in an urban area.
During 1994 clinical information concerning a group of patients attended in the primary care setting of an area of Barcelona city was recorded prospectively on a computerised information sheet.
483 patients were evaluated (age: 68.9 +/- 0.5 years; males: 43.3%; 13.1 +/- 0.4 years of NIDDM evolution), 303 treated without insulin and 180 with insulin. A 37.9% of patients never had carried out self-glucose monitoring and the patients with insulin practised it more frequently (p = 0.03). Levels of basal glycemia, HbA1c' total and HDL cholesterol, basal triglycerides and body mass index were poor in 65.8%, 57.3%, 25.2%, 48.2%, 20.7% and 59.6% of the patients, respectively. Retinopathy and microalbuminuria have never been screened in 32.9% and 95.4% of the patients, respectively: in both cases the situation was worst in those without insulin (p = 0.00 and p = 0.02, respectively). Amaurosis was present in 3.9% of patients, clinical neuropathy in 16.8%, clinical peripheral neuropathy in 19.0%, ischemic heart disease in 13.3%, lower limb amputations in 2.1% and a stroke history in 10.1%. All these complications and the level of HbA1c were higher in patients with insulin (p < 0.05).
The attainment of the recommendations of ENPG is scarce at the primary care level. Patients had insufficient blood glucose self-monitoring, metabolic control and screening for retinopathy and microalbuminuria.
大多数非胰岛素依赖型糖尿病（NIDDM）的护理在初级保健层面提供。本研究的目的是在城市地区的初级保健环境中评估欧洲NIDDM政策组（ENPG）的建议。
1994年期间，前瞻性地将巴塞罗那市某地区初级保健机构中一组患者的临床信息记录在计算机化信息表上。
共评估了483例患者（年龄：68.9±0.5岁；男性：43.3%；NIDDM病程13.1±0.4年），其中303例未使用胰岛素治疗，180例使用胰岛素治疗。37.9%的患者从未进行过自我血糖监测，使用胰岛素的患者更频繁地进行自我血糖监测（p = 0.03）。分别有65.8%、57.3%、25.2%、48.2%、20.7%和59.6%的患者基础血糖、糖化血红蛋白、总胆固醇和高密度脂蛋白胆固醇、基础甘油三酯及体重指数水平较差。分别有32.9%和95.4%的患者从未接受过视网膜病变和微量白蛋白尿筛查：在这两种情况下，未使用胰岛素的患者情况更糟（分别为p = 0.00和p = 0.02）。3.9%的患者出现黑矇，16.8%的患者出现临床神经病变，19.
