An international quality register for South America

GAGLIARDINO JJ

Cape Town, Sotuh Africa

Simposio; 19th World Diabetes Congress.; 2006

International Diabetes Federation

We studied the quality of care provided to people with diabetes in Latin America using the QUALIDIAB Programme. For that purpose we collected 20.425 registries (86% type 2 diabetes, T2DM) in healthcare entities from the Public Health, the Social Security and the Private Subsectors of Argentina, Brazil, Chile, Colombia, Paraguay and Uruguay (QUALIDIAB Net). Quality-of-care indicators (procedures and outcomes) based oninternational reference values were used, together with a Registry Form (clinical, biochemical, therapeutic parameters, and rate of use of diagnostic and therapeutic elements). Results: Number of ambulatory visits,3.7/year.HbA1c ¡Ü 6.5% in 5% T1DM and 12% T2DM. Degree of control of other cardiovascular risk factors (CVRF) in T2DM: overweight/obesity, 83%; systolic blood pressure ¡Ü 130 mm Hg, 27%; total cholesterol ¡Ü200 mg/dL, 43%; HDL-cholesterol ¡Ü 40 mg/dL, 44%; triglyceride ¡Ü 150 mg/dL, 44%; smoking, 13%. Systematic verification of metabolic control indicators and detection of CVRF and diabetes chronic complications:inefficient in 3% to 75% of cases. Therapeutic education indicators: only 50% T1DM and 25% T2DM could play an active role in the control and treatment of their disease. Insulin therapy: administration of 2 NPH + regular daily injections in 37% T1DM; 12% T1DM received > 3 daily insulin injections; diet only, 13% T2DM; insulin only, 19% T2DM. Oral hypoglycemic agents: sulphonylureas were the most widely used (59%), followed by biguanides (38%). Fifty one percent out of 69% of people with hypertension were treated mainly with ACEi and 24% out of 57% of people with dyslipemia received appropriate treatment. Frequency of micro- and macroangiopathic complications: neuropathy, 55%; blindness, 2.4%; ESRD, 1%; AMI, 4.3%; CVA, 3%; amputations, 2.5%; all of them increased and correlated with diabetes duration; maximal increases in renal failure and amputations (about 7-fold). These results demonstrate that we need to improve quality of care of people with diabetes in the Region implementing appropriate interventions and that Qualidiab would be a suitable tool to evaluate the efficacy of specific interventions. Trying to identify the possible role of factors related to healthcare structure and economic investment in the production of the described results, we evaluated risk factor monitoring and their outcomes in persons with T2DM in 3 countries with differing socioeconomic characteristics and healthcare organizations and expenditures; accordingly, we compared frequencies of risk factor monitoring and their outcomes in 4,540 patients with T2DM, matched for gender, age and disease duration from the DIABCARE (France), ANDIAB (Australia) and QUALIDIAB (Latin America) databases. Results: monitoring was less than the 100% internationally recognized quality standard in all three populations. The average rate of monitoring of all risk factors was highest in the DIABCARE population and lowest in that of QUALIDIAB. In terms of outcomes, the percentage of outcome values that met international quality standards averaged approximately 30% for most outcomes in each population. Correlation between monitoring and outcomes, while statistically significant, was of such a small magnitude as to have little, if any, long-term preventive benefit. This assumption is supported by the similar high global coronary risk measured in the three populations. We concluded that while increased investment in healthcare appears to increase process monitoring, it would not be sufficient per se to improve risk factor outcomes to a level likely to reduce future complications and their associated socioeconomic burden. Improvement of the latter will require a complex set of interventions that incorporate education of patients and health professionals and systematic redesign of the environment in which diabetes care is delivered.