Effectiveness of staged diabetes management on the quality of diabetes care in Mexico

Abstract

The aim of this study was to investigate the effectiveness of staged diabetes management, a structured programme developed by the International Diabetes Center in Minneapolis, USA, on the quality of outpatient diabetes care at the primary level in Mexico. A prospective study was conducted in patients treated at outpatient diabetes clinics established in public health centres in 2001-2007 in Hidalgo, Mexico. Diabetes care was provided by multidisciplinary teams which included general physicians and nurses as a minimum. Organisational arrangements were made to reduce waiting times, avoid rotation of staff, and provide adequate time for baseline and follow-up visits. Process and outcomes indicators of quality of diabetes care included body mass index, blood pressure, fasting/casual blood glucose, lipoprotein measurement, haemoglobin A1c, and foot examination. Analysis of 4393 patients showed increases in the percentage of recorded process indicators of quality of diabetes care between baseline and the fifth visit: body mass index 85.5 vs 95.9%; blood pressure measurement 74.4 vs 95.6%; HbA1c 12.9 vs 17.7%; total cholesterol 18.3 vs 55.9%; and foot examination 19.1 vs 94.9%. Significant differences were noted by a decrease in fasting blood glucose (185.75±79.01 vs 162.89±72.53mg/dl, p<0.001), and a 3.6 percentage point decrease in HbA1c (12.05±4.47 vs 8.45±1.89%, p<0.001). These results suggest that it is possible to improve the quality of diabetes care at the primary level; this can be done through the implementation of a programme that integrates: changes in the structure and in the process of care, customised clinical guidelines, and a standardised system of information that enables measuring clinical results with very limited resources. Copyright © 2010 John Wiley & Sons.