Quality of Diabetes Care: The Challenges of an Increasing Epidemic in Mexico. Results from Two National Health Surveys (2006 and 2012)

Abstract

BackgroundThe quality of diabetes care remains suboptimal according to numerous studies assessing the achievement of quality indicators for diabetes care in various healthcare settings. We report about global and specific quality indicators for diabetes care and their association to glycemic control at the population level in two national health surveys in Mexico.MethodsWe conducted a cross-sectional analysis of the 2006 and 2012 National Health Surveys in Mexico. We examined quality of care for 2,965 and 4,483 adults (≥ 20 years) with diagnosed type 2 diabetes using fourteen simple and two composite indicators derived from self-reported information. In a subsample for both surveys, glycated hemoglobin (HbA1c) was measured at the time of the interview. We obtained survey weight-adjusted estimators using multiple regression models (logistic and linear) with combined data files, including survey year as covariate to assess change.ResultsGlobal quality of care in 2012 was 40.8%, with a relative improvement of 11.7% between 2006 and 2012. Detections of cardiovascular disease risk factors (dyslipidemia and hypertension) were the indicators with the highest improvement, while non-pharmaceutical treatment and diabetic foot exams showed minor changes. We found a significant association between the quality of the process of diabetes care and glycemic control (OR 2.53, 95% CI 1.63-3.94). Age more than 65 years old, the type of health subsystem, gender (males), and high socio-economic status were also significantly associated to glycemic control.ConclusionsQuality diabetes care and glycemic control improved and are significantly associated. However, according to international standards, the current situation remains suboptimal. A more holistic approach is needed, with an emphasis on improving quality in outpatient care.

Socio‐economic status and HbA1c in type 2 diabetes: A systematic review and meta‐analysis

“…After screening the titles and abstracts of all references, 262 potentially eligible articles were read full text. Fifty‐five studies met the inclusion criteria of this review . As 2 studies examined identical associations within the same sample, we only included 1 paper in our study .…”

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Changes in the quality of diabetes care in Japan between 2007 and 2015: A repeated cross-sectional study using claims data

“…Clinical guidelines provide tools for the evaluation of the process measures of diabetes care [7][8][9]. Various studies in the United States (US) [10][11][12][13], European countries [14][15][16][17][18][19], South Korea [20], and other countries [21,22] have reported on the quality of diabetes care. Those studies demonstrated the temporal improvements in the quality measures observed; however, patients with diabetes received lower-quality diabetes care in some healthcare settings, with some previous studies demonstrating that patient characteristics and the presence of comorbidities affect the quality of diabetes care [23,24].…”

Distress and its association with self-care in people with type 2 diabetes

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