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

ABSTRACT: The 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.We 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.Global 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.Quality 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.

SUBMITTER: Flores-Hernandez S

PROVIDER: S-EPMC4521912 | biostudies-other | 2015

REPOSITORIES: biostudies-other

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Project description:Background: Population-level health and nutrition surveys provide critical anthropometric data used to monitor trends of the prevalence of under nutrition and overweight in children under 5 years old, and overweight and obesity in the population over 5 years of age. Objective: Analyze the children malnutrition and overweight and obesity in children, teenagers and adults through the National Health and Nutrition Surveys information available from public databases. Materials and Methods: Comparable anthropometric data was gathered by five Mexican National Health and Nutrition Surveys (in Spanish, ENSANUT). In pre-school-age children, under nutrition status was identified through underweight (Z-score below -2 in weight-for-age), stunting (chronic malnutrition) (Z-score below -2 for length/height-for-age), or wasting (Z-score below -2, for weight-for-length/height); overweight status was defined as a body mass index (BMI, kg/m2) for age over +2. For school-age children and adolescents, a Z-score BMI between +1 and +2 deviations was defined as overweight, and between +2 and +5.5 as obesity. In adults (≥20 years of age), overweight status was classified as a BMI between 25.0 and 29.9, and obesity as ≥30. Results: The anthropometric data presented derives from the databases of five survey years of the Mexican National Health and Nutrition Survey: 2006, 2012, 2016, 2018, and 2020. They include a total of 210,915 subjects with complete anthropometric data (weight, length/height) distributed on five survey moments; subjects were categorized by age group: pre-school-age children (n = 25,968), school-age children (n = 42,255), adolescents (n = 39,275), and adults (n = 103,417). Prevalence of malnutrition by indicator was calculated: in pre-school-age children: low height- and weight-for-age, low weight-for-height, and overweight; and in school-age children, adolescents, and adults, the indicators calculated were overweight and obesity. Conclusions: Results demonstrate the importance of maintaining systematic, reliable, and timely national anthropometric data in the population, in order to detect and track trends and to form the basis of nutrition-related public policy.

Project description:BackgroundLifestyles such as unhealthy diets and the lack of physical activity have been contributed to the increased prevalence of obesity. In 2012, the world health organization published the first global recommendation for physical activity and health. People who do not meet at least 150 minutes of moderate-to-vigorous physical activity are considered to be physically inactive. The prevalence of physical inactivity worldwide is 31%, however there is insufficient data from prevalence and trends of physical inactivity in Mexican population. The purposes of this study are to describe the physical inactivity prevalence and recent trends in Mexican adults and to examine the association between physical inactivity with biologic and sociodemographic characteristics.MethodsRepresentative samples of 17,183 and 10,729 adults (aged 20 to 69 years) who participated in the National Health and Nutrition Survey (ENSANUT) in 2006 and 2012, respectively. Moderate-to-vigorous physical activity (MVPA) was assessed using the short form version of the International Physical Activity Questionnaire (IPAQ), which was administered in face-to-face interviews. Self-reported IPAQ MVPA levels were adjusted using an equation derived from a previous validation study. Participants were considered inactive if they engaged in <150-minutes/week of moderate physical activity or <75 minutes/week of vigorous physical activity according to WHO classification criteria.ResultsThe prevalence of physical inactivity was significantly higher in 2012 (19.4%, 95% CI: 18.1, 20.7) than in 2006 (13.4%, 95% CI: 12.5, 14.5). Adults in the obese category, 60-69 age group, and those in the highest socioeconomic status tertile were more likely to be physically inactive.ConclusionsThe proportion of the Mexican adult population who do not meet the minimum WHO physical activity criteria has increased by 6% points between 2006 and 2012. Given the increasing prevalence of obesity, the aging of the population, and the shift in socioeconomic status in Mexico, physical inactivity could continue to increase in the coming years unless effective public health interventions are implemented.

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

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