Abstract
Objetivo
Evaluar las modificaciones en la prevalencia de las complicaciones y la incidencia de episodios finales en pacientes diabeticos durante 5 anos de seguimiento, asi como la efectividad sobre los indicadores de proceso de un protocolo de atencion diabetologica.
Diseno
Estudio observacional prospectivo entre 1991 y 1996.
Emplazamiento
Centro de atencion primaria.
Participantes
Pacientes diabeticos controlados entre 1991 y 1996.
Mediciones y resultados principales
Variables sociodemograficas, epidemiologicas de la DM, factores de riesgo cardiovasculares, presencia de complicaciones y de episodios finales.
Resultados
Trescientos dieciocho de los 352 pacientes censados en 1991. La edad media fue de 68,6 anos (DE, 11,2), un 39% varones. El seguimiento medio fue de 53 meses (DE, 10). Hubo un aumento de la insulinizacion (19%) y del autoanalisis (34,7%) tanto en varones (χ2, 14,7; p < 0,001) como en mujeres (χ2, 40,5; p < 0,001), independientemente de la edad (χ2, 37,77; p < 0,001).
La prevalencia de complicaciones aumento: microvasculares, del 33,4 al 42,1%, y macrovasculares, del 22,3 al 37,2%. Los episodios finales mas frecuentes fueron: ACV (7,8%) y angor (3,6%). Fallecieron 22 pacientes (6,9%), siendo la cardiopatia isquemica (30%) y las neoplasias (30%) las causas mas frecuentes.
La HTA aumento del 51,6 al 59,8% y la hipercolesterolemia del 42,6 al 47%. La obesidad (42%) y el tabaquismo (28%) se mantuvieron estables.
La tension arterial sistolica descendio 4,7 mmHg y la diastolica 3,76 en mujeres, en mayores de 65 anos y en los mas evolucionados (>; 10 anos). El porcentaje de pacientes que presentaba un buen control tensional (< 135/85 mmHg) mejoro un 6,5% (IC, 1-12,9%). La HbA1c empeoro independientemente del sexo, la edad y los anos de evolucion.
Palabras clave: Complicaciones macrovasculares, Complicaciones microvasculares, Diabetes mellitus tipo 2
Abstract
Objective
To evaluate the modifications in the prevalence of complications and the incidence of end-points in diabetic patients observed for five years, and the effectiveness of a diabetes care protocol on the process indicators.
Design
Prospective observational study between 1991 and 1996.
Setting
Primary care centre.
Participants
Diabetic patients monitored between 1991 and 1996.
Measurements and main results
Social and demographic variables, DM epidemiology variables, cardiovascular risk factors, complications and end-points were measured. 318 of the 352 patients selected in 1991 were followed. Average age was 68.6 (SD 11.2) and 39% were male. Mean observance was for 53 months (SD 10). There was an increase of insulin use (19%) and self-analysis (34.7%) both in men (χ22 = 14.7, p < 0.001) and in women (χ22 = 40.5, p < 0.001), independently of age (χ22 = 37.77, p < 0.001). Complications increased: microvascular ones from 33.4% to 42.1%, macrovascular ones from 22.3% to 37.2%. The most common end-points were CVA (7.8%) and angor (3.6%). 22 patients died (6.9%), with ischaemic cardiopathy (30%) and neoplasm (30%) the most common causes. Hypertension increased from 51.6% to 59.8% and hypercholesterolaemia from 42.6% to 47%. Obesity (42%) and tobacco dependency (28%) remained stable. Systolic blood pressure went down by 4.7 mmHg and diastolic pressure by 3.76 mmHg, and in women, over-65s and those who had had the illness longest (>; 10 years). 6.5% (CI 1-12.9%) of patients improved their blood pressure (< 135/85 mmHg). HbA1c worsened independently of sex, age or years of evolution of diabetes.
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