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Published on: July 5, 2022
[Uncontrolled type 2 diabetes in primary care health center: Modifiable factors and target population]
Francisco J Cuevas Fernández1, Adrián Pérez de Armas2, Elena Cerdeña Rodríguez2
1Atención Primaria, Centro de Salud de Barranco Grande, Servicio Canario de la Salud, Santa Cruz de Tenerife, España; Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, San Cristóbal de la Laguna, Santa Cruz de Tenerife, España.
Aims:
To detect modifiable factors and target populations associated with uncontrolled type 2 diabetes in primary care.
Design:
Retrospective cross-sectional descriptive study.
Location:
Health center of Barranco Grande, Tenerife.
Participants:
Random selection of patients with DM2 attended by 12 family doctors and 12 nurses.
Main Measurements:
In addition to the control of DM2, sociodemographic, clinical data, lifestyle and follow-up of preventive and therapeutic measures were obtained. After bivariate analysis, a multilevel multivariate model was adjusted by taking the quota of patients assisted by each physician as a second-level mixed-effect variable and the rest as first-level variables.
Results:
587 patients were recruited (46.5% female), treated with 1.9-1.1 antidiabetic drugs, with 4.1% therapeutic non-compliance, and suffering 13.8% therapeutic inertia. 23.7% showed poor DM2 control, being significantly worse (p<0.05) in male sex, age <65 years, evolution DM2 -5 years, work-active, upper-middle studies, inadequate diet, metabolic syndrome, ratio TG/HDL-3, complications of DM2, Charlson index<5, nursing visits <3/year, without ECG in the last year, and more drugs prescribed for DM2. The doctor-nurse quota was associated with poor control with an intraclass coefficient of 0.01.
Conclusions:
Men under 65 years of age with DM2 evolution longer than 5 years are a target population to intensify interventions. Therapeutic non-compliance, inadequate diet, lack of adherence protocols and ratio TG/HDL>3 are the main modifiable factors on which to intervene. The association of the doctor-nurse quota with the control of DM2 is weak, probably due to adequate follow-up of preventive programs.
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