Diabetic patient control in Primary Care: Influence of service portfolio and other factors

• Published in: Atención primaria Vol. 52; no. 9; p. 617
• Main Authors: Bayón Cabeza, Marianela, Pérez Rivas, Francisco Javier, Zamora Sarabia, Ana Leonor, de Las Heras Mosteiro, Julio, Becerril Rojas, Beatriz, Rodriguez Barrientos, Ricardo
• Format: Journal Article
• Language: Spanish
• Published: Spain 01-11-2020
• Subjects: Blood Glucose; Comorbidity; Diabetes Mellitus, Type 2 - therapy; Glycated Hemoglobin - analysis; Humans; Primary Health Care; Efectividad de intervenciones; Glycated haemoglobin A; Diabetes mellitus tipo 2; Primary Health Care; Evaluación de resultado (atención de salud); Type 2 diabetes mellitus; Hemoglobina glucosilada; Atención Primaria de salud; Outcome assessment (health care); Effectiveness of interventions
• ISSN: 1578-1275; 1578-1275
• DOI: 10.1016/j.aprim.2020.02.015

To study the effect of the type of follow-up according to Service Portfolio and other associated factors, in the reduction of HbA
levels in people with a new diagnosis of type 2 diabetes and poor initial control.
Analytical observational study of a cohort under routine clinical practice conditions.
262 Primary Health Care Centres in Madrid.
1,838 individuals older than 18 years with a new diagnosis of type 2 DM and initial HbA1c levels ≥ 7%, or ≥ 8.5% if older than 75 years.
The exposure variable was the type of follow-up according to Portfolio, categorised as minimum, medium, and optimal, according to the number of interventions performed and periodicity of type of therapeutic-pharmacological plan.
A study was made of the comorbidity, therapeutic-pharmacological plan, diet - exercise advice and deprivation index. The main outcome was the difference between the final and initial HbA1c.
After 2 years of follow-up there was a mean decrease in HbA
by -1.7 percentage points (95% CI: -1.6;-1.8), which was 0.36 points higher in patients with optimal follow-up: -2.1 (95% CI: -1.7;-2.4). The factors associated with a decrease in HbA1c were the optimal follow-up -0.29 (95% CI: -0.5;-0.1), the medium follow-up -0.26 (95% CI: -0.5; -0.0), and the initial HbA1c value -0.9 (95% CI: -0.9; -0.9. The factors associated with the increase were insulin treatment and living in socially disadvantaged areas.
Glycaemic control was improved in patients with a new diagnosis of diabetes in which optimal follow-up is performed as proposed in the Service Portfolio.