Are recommended standards for diabetes care met in Central and South America? A systematic review

Mudaliar, Uma; Kim, Woon-Cho; Kirk, Katy; Rouse, Chaturia; Narayan, K.M. Venkat; Ali, Mohammed K.

doi:10.1016/j.diabres.2013.01.010

Cited by 26 publications

(12 citation statements)

References 54 publications

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“…Recent reviews have shown that quality of care for diabetes in the US [3], Europe [4], and Latin America [5] remains suboptimal, highlighting the existence of important disparities in the provision of diabetes care, with considerable gaps in the care provided to different population groups [6]. Although socioeconomic and ethnic disparities have been more frequently reported [7,8], several studies have also analyzed urban-rural disparities in access to and quality of DM2 care [9,10].…”

Section: Introductionmentioning

confidence: 99%

Improving Diabetes Care in Rural Areas: A Systematic Review and Meta-Analysis of Quality Improvement Interventions in OECD Countries

et al. 2013

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Background and AimsDespite well documented disparities in health and healthcare in rural communities, evidence in relation to quality improvement (QI) interventions in those settings is still lacking. The main goals of this work were to assess the effectiveness of QI strategies designed to improve diabetes care in rural areas, and identify characteristics associated with greater success.MethodsWe conducted a systematic review and meta-analysis. Systematic electronic searches were conducted in MEDLINE, EMBASE, CINAHL, and 12 additional bibliographic sources. Experimental studies carried out in the OECD member countries assessing the effectiveness of QI interventions aiming to improve diabetes care in rural areas were included. The effect of the interventions and their impact on glycated hemoglobin was pooled using a random-effects meta-analysis.ResultsTwenty-six studies assessing the effectiveness of twenty QI interventions were included. Interventions targeted patients (45%), clinicians (5%), the health system (15%), or several targets (35%), and consisted of the implementation of one or multiple QI strategies. Most of the interventions produced a positive impact on processes of care or diabetes self-management, but a lower effect on health outcomes was observed. Interventions with multiple strategies and targeting the health system and/or clinicians were more likely to be effective. Six QI interventions were included in the meta-analysis (1,496 patients), which showed a significant reduction in overall glycated hemoglobin of 0.41 points from baseline in those patients receiving the interventions (95% CI -0.75% to -0.07%).ConclusionsThis work identified several characteristics associated with successful interventions to improve the quality of diabetes care in rural areas. Efforts to improve diabetes care in rural communities should focus on interventions with multiple strategies targeted at clinicians and/or the health system, rather than on traditional patient-oriented interventions.

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Section: Introductionmentioning

confidence: 99%

Improving Diabetes Care in Rural Areas: A Systematic Review and Meta-Analysis of Quality Improvement Interventions in OECD Countries

et al. 2013

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“…In particular, patients living in developing countries experience additional problems, such as poor support and limited access to healthcare services [6]. In this context, an integrated, multidisciplinary health system focused on prevention and education strategies is the key to provide adequate care to diabetic patients.…”

Section: Discussionmentioning

confidence: 99%

Effects of nurse telesupport on transition between specialized and primary care in diabetic patients: study protocol for a randomized controlled trial

Moreira

Marobin

Rados

et al. 2017

Trials

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BackgroundAccording to the Global Diabetes Plan, a unified health system with preventive and educational strategies is essential to proper diabetes care and primary settings should be the main site of care. In Brazil, there is limited access to outpatient hospital diabetes services, while primary-care diabetes support is underutilized. Telemedicine can be a useful adjunct to support discharge of stable patients with type 2 diabetes to the primary care setting. In this paper, we present a randomized controlled trial (RCT) protocol designed to evaluate the effects of telehealth support for stable type 2 diabetes patients discharged from hospital outpatient diabetes clinics.MethodsWe designed a RCT. Patients with stable type 2 diabetes (glycated hemoglobin < 8%) considered eligible for discharge from specialized to primary care will be included. Those with uncontrolled ischemic heart disease, severe neuropathy, and stage IV/V nephropathy will be excluded. Enrolled patients will be randomized into two groups: follow-up supported by periodic phone calls by a nurse (intervention group) plus primary care or routine primary care only (control group). The intervention group will receive regular telephone calls (every three months for one year) and will have a toll-free number to call in case of questions about disease management. The main outcome measure is a comparison of glycemic control between groups (assessed by glycated hemoglobin) at one-year follow-up.DiscussionWe plan to evaluate the effectiveness of a telephone-based intervention on glycemic control in patients with type 2 diabetes followed by primary care teams. Telemedicine can be an important adjunct in type 2 diabetes management, improving patient education and knowledge about the disease. Furthermore, it can help the healthcare system by alleviating overload in specialized care settings and supporting the stewardship role of primary care.Trial registrationClinical Trials, NCT02768480. Registered on 29 April 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-1954-z) contains supplementary material, which is available to authorized users.

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“…Only 33% of patients in North Africa 11 and 30% of individuals with type 2 DM in some regions of Finland perform urinary albumin tests on a yearly basis 12 . A recent systematic review evaluating the standards for DM care in Central and South America found that the prevalence of annual albuminuria screenings among patients with DM ranged from 1-80%, which reveals the presence of significant heterogeneity in patient care, with important barriers to healthcare 13 . Fortunately, some countries have much higher albuminuria screening rates, such as Israel, where approximately 72.6% of patients undergo annual screening tests 11 .…”

Section: Discussionmentioning

confidence: 99%

Availability of urinary albumin measurement in Southern Brazilian Laboratories

Soares¹,

Cheuiche²,

Silva³

et al. 2015

cbr

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Are recommended standards for diabetes care met in Central and South America? A systematic review

Cited by 26 publications

References 54 publications

Improving Diabetes Care in Rural Areas: A Systematic Review and Meta-Analysis of Quality Improvement Interventions in OECD Countries

Improving Diabetes Care in Rural Areas: A Systematic Review and Meta-Analysis of Quality Improvement Interventions in OECD Countries

Effects of nurse telesupport on transition between specialized and primary care in diabetic patients: study protocol for a randomized controlled trial

Availability of urinary albumin measurement in Southern Brazilian Laboratories

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