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Li PI, Guo HR. Long-term quality-of-care score for predicting the occurrence of acute myocardial infarction in patients with type 2 diabetes mellitus. World J Diabetes 2023; 14:1091-1102. [PMID: 37547581 PMCID: PMC10401448 DOI: 10.4239/wjd.v14.i7.1091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/20/2023] [Accepted: 05/17/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death globally, and diabetes mellitus (DM) is a well-established risk factor. Among the risk factors for CVD, DM is a major modifiable factor. In the fatal CVD outcomes, acute myocardial infarction (AMI) is the most common cause of death.
AIM To develop a long-term quality-of-care score for predicting the occurrence of AMI among patients with type 2 DM on the basis of the hypothesis that good quality of care can reduce the risk of AMI in patients with DM.
METHODS Using Taiwan’s Longitudinal Cohort of Diabetes Patient Database and the medical charts of a medical center, we identified incident patients diagnosed with type 2 DM from 1999 to 2003 and followed them until 2011. We constructed a summary quality-of-care score (with values ranging from 0 to 8) with process indicators (frequencies of HbA1c and lipid profile testing and urine, foot and retinal examinations), intermediate outcome indicators (low-density lipoprotein, blood pressure and HbA1c), and co-morbidity of hypertension. The associations between the score and the incidence of AMI were evaluated using Cox regression models.
RESULTS A total of 7351 patients who had sufficient information to calculate the score were enrolled. In comparison with participants who had scores ≤ 1, those with scores between 2 and 4 had a lower risk of developing AMI [adjusted hazard ratio (AHR) = 0.71; 95% confidence interval (95%CI): 0.55-0.90], and those with scores ≥ 5 had an even lower risk (AHR = 0.37; 95%CI: 0.21-0.66).
CONCLUSION Good quality of care can reduce the risk of AMI in patients with type 2 DM. The quality-of-care score developed in this study had a significant association with the risk of AMI and thus can be applied to guiding the care for these patients.
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Affiliation(s)
- Pi-I Li
- Department of Family Medicine, Chi Mei Medical Center, Tainan 710, Taiwan
- Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan 717, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan 704, Taiwan
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Garay J, Camacho PA, Lopez-Lopez J, Alvernia J, Garcia M, Cohen DD, Calderon C, Lopez-Jaramillo P. Survey of knowledge for diagnosing and managing prediabetes in Latin-America: cross-sectional study. Diabetol Metab Syndr 2019; 11:102. [PMID: 31827627 PMCID: PMC6894241 DOI: 10.1186/s13098-019-0500-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/28/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Prediabetes has been proposed as a risk factor for the development of type 2 diabetes mellitus (DM2) and cardiovascular disease (CVD). Despite the clinical importance of prediabetes, little is known about the level of knowledge, beliefs and barriers to screening and treating prediabetes amongst care health providers in Latin America. The aim of the present survey was to evaluate the knowledge and beliefs about prediabetes amongst in Latin American health care providers. METHODOLOGY In a cross-sectional study, we adapted the written survey designed by the Johns Hopkins University group, and applied it to health care providers across Latin America during three meetings, in 2017, and with physicians from primary care centers in Bucaramanga, Colombia convened in 2017. The survey consisted of questions under four headings, diabetes screening, management of prediabetes, pharmacological treatment-metformin use, and demographic information. We perform a descriptive analysis to determine the differences in responses between different medical specialties. RESULTS The majority of the care providers that answered the survey were Colombian physicians, 54.5% of respondents had 10 years or more since completing their training and more women responded. Only 9.5% identified the 12 prediabetes risk factors described in the literature. The most common risk factor identified was a family history of diabetes, followed by overweight, a sedentary lifestyle and dyslipidemia, while ethnicity was the risk factor least commonly. 47.1% answered that laboratory tests to detect prediabetes are fasting glucose and HbA1C, 82.5% correctly identified fasting plasma glucose as the best test, 35.9% correctly responded that to the recommended weight loss goal is 5 to 7% and 49.1% that 150 min is considered the minimum level of physical activity per week. 78% agreed that the identification and treatment of prediabetes is important. 56% believed that patients with prediabetes progress more rapidly to diabetes and 40.6% considered that metformin could reduce the risk of diabetes in patients already diagnosed with prediabetes. CONCLUSION These results demonstrate that there are important gaps in the knowledge of the diagnosis, clinical implications and management of prediabetes amongst Latin America health providers.
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Affiliation(s)
- Jennifer Garay
- Research Department, Fundacion Oftalmologica de Santander (FOSCAL) Internacional, Calle 158 # 20-95, Consultorio 101/102, Floridablanca, Santander Colombia
| | - Paul A. Camacho
- Research Department, Fundacion Oftalmologica de Santander (FOSCAL) Internacional, Calle 158 # 20-95, Consultorio 101/102, Floridablanca, Santander Colombia
- Medical School, Universidad Autónoma de Bucaramanga (UNAB), Floridablanca, Colombia
| | - Jose Lopez-Lopez
- Research Department, Fundacion Oftalmologica de Santander (FOSCAL) Internacional, Calle 158 # 20-95, Consultorio 101/102, Floridablanca, Santander Colombia
| | - Juliana Alvernia
- Research Department, Fundacion Oftalmologica de Santander (FOSCAL) Internacional, Calle 158 # 20-95, Consultorio 101/102, Floridablanca, Santander Colombia
| | - Marcela Garcia
- Research Department, Fundacion Oftalmologica de Santander (FOSCAL) Internacional, Calle 158 # 20-95, Consultorio 101/102, Floridablanca, Santander Colombia
| | - Daniel D. Cohen
- Research Department, Fundacion Oftalmologica de Santander (FOSCAL) Internacional, Calle 158 # 20-95, Consultorio 101/102, Floridablanca, Santander Colombia
- Instituto Masira, Medical School, Universidad de Santander (UDES), Bucaramanga, Colombia
| | - Carlos Calderon
- Fundación Santandereana de Diabetes (FUSANDE), Cra. 33 #46-45, Bucaramanga, Santander Colombia
| | - Patricio Lopez-Jaramillo
- Research Department, Fundacion Oftalmologica de Santander (FOSCAL) Internacional, Calle 158 # 20-95, Consultorio 101/102, Floridablanca, Santander Colombia
- Medical School, Universidad Autónoma de Bucaramanga (UNAB), Floridablanca, Colombia
- Instituto Masira, Medical School, Universidad de Santander (UDES), Bucaramanga, Colombia
- Eugenio Espejo Medical School, Universidad UTE, Quito, Ecuador
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