UNIVERSIDAD NACIONAL MAYOR DE SAN MARCOS FACULTAD DE MEDICINA

E De, Medicina Humana
unpublished
Objective: To report the frequency of poor glycemic control and to identify key factors associated with it, especially the complexity and type of treatment and the number of medical visits in a Low-Middle Income Country setting. Methods: This is a cross-sectional study, which analyzed data from the 2014-2015 Peruvian Surveillance Program of Diabetes from Outpatients of the National Hospital Arzobispo Loayza. The inclusion criteria were the following: more than one year of diagnosis of type 2
more » ... betes mellitus, more than 18 years old, normal hemoglobin and creatinine, non-diagnosis of TB or cancer, and at least one glycated hemoglobin (HbA1c) test in a year. An HbA1c result above 7% was considered poor glycemic control, according to the American Diabetes Association Other outcomes, such as age, sex, length of disease and type of treatment were analyzed looking for association with glycemic control. Results: Of 3073 patients from the Surveillance data, we included 749 (24.4%) that meet selection criteria. Mean age was 60.5 (SD=10.9) years, median duration of diabetes was 7 years (3-13), and proportion of female patients was 64.4%. According to American Diabetes Association, 71.6% patients had poor glycemic control (defined as HbA1c levels ≥ 7.0%). In the multivariate analysis, the use of insulin was strongly associated with poor glycemic control (OR: 4.15, 95% CI: 2.1-9.19, p<0.001). Insulin associated with oral therapy was also strongly associated with poor glycemic control (OR: 5.12, 95% CI: 2.7-10.76, p<0.001); which is consistent with findings reported in studies from other low-middle income countries. The number of medical visits and having health insurance were not associated factors to poor glycemic control. Conclusions: The frequency of poor glycemic control was 71.6%. The use of insulin with or without oral therapy was strongly associated to poor glycemic control. The number of visits and having health insurance had no association with glycemic control. Further studies should be done to explore these associations and evaluate strategies for improving glycemic control. ) CGI = Control glicémico inadecuado *Países en cada grupo según la definición propuesta por el Banco Mundial. † Representa el número de pacientes que contó con hemoglobina glicosilada en cada estudio y qué porcentaje de la muestra inicial representó este número.
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