Background
This study was developed to evaluate quality indicators in type 2 diabetes patient care at the Unified Public Health System’s primary and tertiary health care centers within a local population.
Methods
This was a retrospective cohort of 488 patients with type 2 diabetes (148 in each primary health care unit, ESF and UBS, and 192 at the tertiary health care unit) with a 1-year follow-up to evaluate the following care quality indicators: nephropathy, neuropathy and retinopathy tests, yearly lipid profile and nutritional assessments, and an inquiry about tobacco use. The presence of > 50% of the quality of care assessment measures was considered acceptable. Indicators were also evaluated in relation to patients without proper diabetes control (HbA1c > 8.5%).
Results
In the results, a high percentage of patients were excluded specifically for not presenting the two HbA1c tests within a year (n = 208, 58.1% at ESF; n = 225, 58.4% at UBS; and n = 39, 16.9% at the tertiary health care unit). From the included patients, only 7 (4.7%) at ESF, 7 (4.7%) at UBS, and 52 (27.0%) at the tertiary health care unit showed > 50% of the quality criteria covered. When only patients without proper diabetes control were evaluated, none of them at any of the health care units showed all the quality criteria covered.
Conclusions
Our results show a low percentage of care assessment measures at each evaluated health care unit, pointing out the need to improve the protocols and care lines of diabetic patients.
Type 2 diabetes (T2DM) is a chronic disease that requires multidisciplinary patient-centered treatment. Although important, promoting self-care strategies is still a challenge.
Methods: Patients with T2DM and poor glycemic control (HbA1c > 7.5%) were randomly assigned to participate in the Self-Care Multidisciplinary Workshop for Diabetes (MW) or usual care (UC). The MW consisted of 15-minute individual meetings with each T2DM providers (nurse, pharmacist, dietitian, physical educator and social worker) to approach diabetes self-care topics. It was offered in 3 different modules through 12 weeks aiming to bring knowledge and skills necessary for patients to improve their diabetes care. UC included 3 brief meetings in which printed educational folders were provided. Both groups maintained standard care at outpatient T2DM clinic with endocrinologists. Generalized estimating equation model was performed to assess HbA1c, Diabetes-related Quality of Life and Summary of Diabetes Self-Care Activities questionnaires variation from baseline to 12 months.
Results: Ninety-six patients (59 ±9 years-old, 60% women, diabetes duration of 16 ±10 years, 62% medium-low/low socio-economic status, HbA1c 9.6 ±1.4%) were included. Variation from baseline of HbA1c [UC -0.52% (CI 95% -1.08 to 0.26) vs. MW -0.30% (CI 95% -1.05 to 0.45) p=0.072], healthful eating plan in the last 7 days (d) [UC -0.22 d (CI 95% -1.27 to 0.82) vs. MW -0.03 d (CI 95% -0.85 to 0.79) p=0.15] and foot exam in the last 7 d [UC 0.51 d (CI 95% -0.75 to 1.77) vs. MW 1.1 d (CI 95% -0.16 to 2.39) p=0.329] to 12 months were not different between groups. There was a decrease in worry about future effects of diabetes in MW [-0.46 (CI -0.81 to -0.12)], not found in UC [0.11 (CI -0.20 to 0.42) p=0.004].
Conclusion: A short-term MW reduced worry about diabetes but failed to improve glycemic control and self-care activities in long-standing T2DM patients of a low-income country.
ClinicalTrials.gov Identifier: NCT03074383.
Disclosure
S. Piccoli Garcia: None. G.H. Telo: None. J. Schneiders: None. C. Blume: None. G. Berlanda: None. K. Sparrenberger: None. A.N. Gossenheimer: None. M.M. Madalosso: None. L.G. Bottino: None. A.S.O. Schein: None. A.C.P. Macedo: None. L. Helal: None. C. Christofoli: None. L.P. Santos: None. B.D. Schaan: None.
Funding
Fundo de Incentivo à Pesquisa e Eventos do Hospital de Clínicas de Porto Alegre
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Objective: To evaluate the association between knowledge about the disease, adherence to self-care, and glycemic control in people diagnosed with type 1 diabetes mellitus. Subjects and methods: A cross-sectional study of patients aged over 18 years diagnosed with type 1 diabetes mellitus, treated at an outpatient clinic of a Brazilian university hospital. Participants with other types of diabetes, cognitive impairment, pregnancy, and outpatient discharge were excluded. Data were collected from January to March 2021 (by telephone call), with questions about the participants' profile, diabetes knowledge questionnaire (DKN-A), and self-care inventory revised (SCI-R) translated into and adapted for Brazilian Portuguese. Data analysis involved chi-square associations, Mann-Whitney U tests, and Poisson regression. Results: Among 198 adult participants, the mean age was 42 ± 12 years, 53.5% were women, the mean glycated hemoglobin was 8.6 ± 1.6%, 140 (70.8%) had satisfactory knowledge about diabetes, 65 (32.8%) had adherence to self-care, and 46 (23.2%) had adequate glycemic control. We found an association between knowledge and adherence to self-care (p < 0.001). Knowledge was not associated with glycemic control (p = 0.705). Conclusion: Knowledge about diabetes was associated with greater adherence to self-care in people with type 1 diabetes mellitus, but it did not reflect in better glycemic control.
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