Abstract

VILLEGAS PERRASSE, ALBERTO; GOMEZ CHVATAL, ANA MARÍA  and  BEDOYA GOMEZ, CATALINA. CONTROL AND CHRONIC COMPLICATIONS OF DIABETES MELLITUS IN AN OUTPATIENT ATTENTION CENTER IN MEDELLÍN, COLOMBIA, 1998-2001.. Iatreia [online]. 2004, vol.17, n.1, pp.11-23. ISSN 0121-0793.

DIABETES MELLITUS control requires a constant, continuous and strict evaluation of many factors that inherently affect its course, not only from the point of view of glycemia, but also from other aspects of the metabolic disorder produced by diabetes itself, by other diseases associated with it and by health habits that influence its control and the appearance of complications derived from it. In order to identify this particular situation in the Diabetes Program of the outpatient attention center of the Instituto de Seguro Social (ISS), we evaluated diabetes control, the presence of associated diseases, health habits, chronic complications and the degree of control of many parameters. Methods: We conducted a descriptive, prospective, cross-sectional trial in which, from the total of 1.450 medical charts of patients attending such program and by means of simple randomization and replacement, 304 medical charts were selected of patients that met the inclusion criteria from January 1998 to December 2001. A structured form was applied to all the selected charts in order to evaluate the main clinical features, the presence of associated disease (hypertension, dyslipidemia and obesity), the most significant health habits, the presence of complications and the relationship of control parameters with international standards. Data were registered using Epi- Info 6.0; we processed data obtaining absolute and relative frequencies, and in order to do estimates of association we used contingency tables using Pearson’s chi square with a p significance of < 0.05. RESULTS: OF THE 304 MEDICAL charts reviewed, 91% were from type 2 diabetics and 64% were from women. Diseases associated to diabetes were hypertension 69%, dyslipidemia 64%, obesity 37%. Patients’ life style were as follows: 55% were exercising, 41% were former smokers, 12% were active smokers, 27% ate sugar, 51% ate fat and 8% performed selfmonitoring of blood glucose levels. Chronic complications were: cardiovascular 48,4%, eyerelated 57.4%, renal 31,5%, neuropathy 28,6% and diabetic foot 24%. Less than 50% of the patients had reached goals in controlling glycemia, HbA1c, total cholesterol, HDL cholesterol and systolic blood pressure. In the control of triglycerides and diastolic blood pressure, 62% and 76.3%, respectively had reached the goals of control. When association tests among different variables were performed, we only found association between the type of diabetes and the presence of hypertension and cardiovascular disease (p <0.000 for both). CONCLUSIONS: IN DIABETIC PATIENTS ATTENDING the outpatient diabetes control program of the ISS sectional Antioquia, diabetes is associated to other metabolic syndrome components in high proportion; these patients have a high incidence of chronic complications which varies from 24 to 58%, thus enhancing their morbility and mortality and they represent an important burden to the health system. We emphasize on the need of early detection in order to do a proper control and to carry out therapeutic and educational strategies to prevent or slow down the appearance of complications.

Keywords : DIABETES MELLITUS; CARDIOVASCULAR RISK FACTORS; CHRONIC COMPLICATIONS; METABOLIC CONTROL.

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