Glycemic control and HbA1c variations in patients with diabetes mellitus seen in live consultation and in remote consultation in a Peruvian hospital
Abstract
Objective: To assess glycemic control in patients with diabetes mellitus (DM) seen in live consultation or remote consultation, and to identify factors associated with variations in glycated hemoglobin (HbA1c) values. Materials and methods: We did a retrospective cohort study that included patients >18 years old who were seen in live consultation or remote consultation because of DM in Alberto Sabogal-Sologuren National Hospital, during June 2021. Clinical data from electronic clinical records were obtained, including baseline and at 11-month follow-up HbA1c values. We used Poisson regression with robust variance for calculating relative risk (RR) and 95% confidence intervals (CI), for identifying factors associated with ≥0.5 HbA1c variations during follow-up. Results: Four-hundred and sixteen patients were included, their mean age was 62 years, 57.2% were female, and 68.5% had remote consultation. The percentage of patients with HbA1C <7% increased from 21,7 to 27,4% during follow-up, while in those with HbA1C ≥10%, there was a reduction, from 38,2 to 19,1%. Amongst patients with baseline HbA1c ≥7%, having baseline HbA1c ≥10% was associated with ≥0,5% reduction in HbA1c values (adjusted RR: 2,97; 95% CI: 1,61-5,50). The consultation modality (live or remote) was not associated with significant variations in HbA1c levels. Conclusions: One fifth of patients had optimum glycemic control at baseline, and this rate increased during follow-up. Those who had baseline HbA1C ≥10% had greater frequency in HbA1c level reduction, although the consultation modality (live or remote) was not associated with variations in HbA1c levels.
Downloads
References
International Diabetes Federation. Diabetes estimates (20-79 y): People with diabetes, in 1,000s [Internet]. 2021 [cited 2022 Aug 8]. Disponible en: https://diabetesatlas.org/data/en/indicators/1/.
Pan American Health Organization. The burden of Diabetes mellitus in the Region of the Americas, 2000-2019 [Internet]. 2021 [cited 2022 Jul 13]. Disponible en: https://www.paho. org/en/noncommunicable-diseases-and-mental-health/ noncommunicable-diseases-and-mental-health-data-19.
Paul SK, Klein K, Thorsted BL, Wolden ML, Khunti K. Delay in treatment intensification increases the risks of cardiovascular events in patients with type 2 diabetes. Cardiovasc Diabetol [Internet]. 2015;14(1):1–10. Disponible en: https://doi.org/10.1186/s12933- 015-0260-x DOI:10.1186/S12933-015-0260-X/TABLES/3.
Osataphan S, Chalermchai T, Ngaosuwan K. Clinical inertia causing new or progression of diabetic retinopathy in type 2 diabetes: A retrospective cohort study. J Diabetes. 2017;9(3):267–74. DOI:10.1111/1753-0407.12410.
Imai C, Li L, Hardie RA, Georgiou A. Adherence to guideline- recommended HbA1c testing frequency and better outcomes in patients with type 2 diabetes: a 5-year retrospective cohort study in Australian general practice. BMJ Qual Saf. 2021;30(9):706–14. DOI:10.1136/bmjqs-2020-012026.
Eberle C, Stichling S. Impact of COVID-19 lockdown on glycemic control in patients with type 1 and type 2 diabetes mellitus: a systematic review. Diabetol Metab Syndr. 2021;13(1):1–8. DOI:10.1186/S13098-021-00705-9/TABLES/1.
Munekawa C, Hosomi Y, Hashimoto Y, Okamura T, Takahashi F, Kawano R, et al. Effect of coronavirus disease 2019 pandemic on the lifestyle and glycemic control in patients with type 2 diabetes: a cross-section and retrospective cohort study. Endocr J. 2021;68(2):201–10. DOI:10.1507/endocrj.EJ20-0426.
Tanji Y, Sawada S, Watanabe T, Mita T, Kobayashi Y, Murakami T, et al. Impact of COVID-19 pandemic on glycemic control among outpatients with type 2 diabetes in Japan: A hospital-based survey from a country without lockdown. Diabetes Res Clin Pract. 2021;176:108840. DOI:10.1016/J.DIABRES.2021.108840.
Pesantes MA, Lazo-Porras M, Cárdenas MK, Diez-Canseco F, Tanaka- Zafra JH, Carrillo-Larco RM, et al. Los retos del cuidado de las personas con diabetes durante el estado de emergencia nacional por COVID-19 en Lima, Perú: recomendaciones para la atención primaria. Rev Peru Med Exp Salud Publica. 2020;37(3):541–6. DOI:10.17843/RPMESP.2020.373.5980.
Lopez-Huamanrayme E, Salsavilca-Macavilca E, Taype-Rondan A. Impacto de la pandemia por COVID-19 en la consulta ambulatoria endocrinológica y teleconsulta en un hospital Peruano. Rev del Cuerpo Médico Hosp Nac Almanzor Aguinaga Asenjo. 2022;15(3). DOI:10.35434/RCMHNAAA.2022.153.1407.
JohnsHopkinsUniversity.COVID-19DataRepositorybytheCenter for Systems Science and Engineering (CSSE) at Johns Hopkins University [Internet]. 2022 [cited 2022 Jul 8]. Disponible en: https:// github.com/CSSEGISandData/COVID-19
H50deMindray,AnalizadorAutomáticodeHPLC[Internet].2022 [cited 2022 Jun 12]. Disponible en: https://wwww.mindray.com/ es/product/H50.html.
McAlister FA, Lethebe BC, Lambe C, Williamson T, Lowerison M. Control of glycemia and blood pressure in British adults with diabetes mellitus and subsequent therapy choices: a comparison across health states. Cardiovasc Diabetol [Internet]. 2018 [cited 2024 May 12];17(1). Disponible en: https://pubmed.ncbi.nlm.nih. gov/29433515/ DOI:10.1186/S12933-018-0673-4.
AmericanDiabetesAssociationProfessionalPracticeCommittee. Glycemic Targets: Standards of Medical Care in Diabetes - 2022. Diabetes Care [Internet]. 2022;45(Supplement_1):S83–96. Disponible en: https://doi.org/10.2337/dc22-S006 DOI:10.2337/ DC22-S006.
American Association of Clinical Endocrinologists. Glycemic Management in Type 2 Diabetes [Internet]. 2022 [cited 2022 Jul 8]. Disponible en: https://pro.aace.com/disease-state-resources/ diabetes/depth-information/glycemic-management-type-2- diabetes.
CamaraA,BaldéNM,Sobngwi-TambekouJ,KengneAP,DialloMM, Tchatchoua APK, et al. Poor glycemic control in type 2 diabetes in the South of the Sahara: the issue of limited access to an HbA1c test. Diabetes Res Clin Pract. 2015;108(1):187–92. DOI:10.1016/J. DIABRES.2014.08.025.
PatelSY,McCoyRG,BarnettML,ShahND,MehrotraA.Diabetes Care and Glycemic Control During the COVID-19 Pandemic in the United States. JAMA Intern Med [Internet]. 2021;181(10):1412–4. Available from: https://doi.org/10.1001/jamainternmed.2021.3047 DOI:10.1001/JAMAINTERNMED.2021.3047.
PalancaA,Quinones-TorreloC,GirbésJ,RealJT,Ampudia-BlascoFJ. Impact of COVID-19 lockdown on diabetes management and follow- up in a broad population in Spain. Eur J Clin Invest. 2022;52:e13771. DOI:10.1111/ECI.13771.
Calderon-Ticona JR, Taype-Rondan A, Villamonte G, Labán- Seminario LM, Helguero-Santín LM, Miranda JJ, et al. Diabetes care quality according to facility setting: A cross-sectional analysis in six Peruvian regions. Prim Care Diabetes. 2021;15(3):488–94. DOI:10.1016/J.PCD.2020.11.014.
Gomes MB, Tang F, Chen H, Cid-Ruzafa J, Fenici P, Khunti K, et al. Socioeconomic Factors Associated With Glycemic Measurement and Poor HbA1c Control in People With Type 2 Diabetes: The Global DISCOVER Study. Front Endocrinol (Lausanne). 2022;13:831676. DOI:10.3389/FENDO.2022.831676.
Basto-Abreu A, Barrientos-Gutiérrez T, Rojas-Martínez R, Aguilar-Salinas CA, López-Olmedo N, De la Cruz-Góngora V, et al. Prevalencia de diabetes y descontrol glucémico en México: resultados de la Ensanut 2016. Salud Publica Mex. 2022;62(1):50–9. DOI:10.21149/10752.
MoreiraRO,ViannaAGD,FerreiraGC,dePaulaMA.Determinantsof glycemic control in type 2 diabetes mellitus in Brazil: A sub-analysis of the longitudinal data from the BrazIian type 1 & 2 diabetes disease registry (BINDER). Prim Care Diabetes. 2022;16(4):562–7. DOI:10.1016/J.PCD.2022.04.003.
Anderson SL, Trujillo JM, McDermott M, Saseen JJ. Determining predictors of response to exenatide in type 2 diabetes. J Am Pharm Assoc. 2012;52(4):466–71. DOI:10.1331/JAPHA.2012.10217.
Zhao Q, Li H, Ni Q, Dai Y, Zheng Q, Wang Y, et al. Follow-up frequency and clinical outcomes in patients with type 2 diabetes: A prospective analysis based on multicenter real-world data. J Diabetes. 2022;14(5):306–14. DOI:10.1111/1753-0407.13271.
Ruissen MM, Regeer H, Landstra CP, Schroijen M, Jazet I, Nijhoff MF, et al. Increased stress, weight gain and less exercise in relation to glycemic control in people with type 1 and type 2 diabetes during the COVID-19 pandemic. BMJ open diabetes Res care. 2021;9:002035. DOI:10.1136/BMJDRC-2020-002035.
Raghavan S, Warsavage T, Liu WG, Raffle K, Josey K, Saxon DR, et al. Trends in Timing of and Glycemia at Initiation of Second- line Type 2 Diabetes Treatment in U.S. Adults. Diabetes Care. 2022;45(6):1335–45. DOI:10.2337/DC21-2492.
Kim K, Unni S, McAdam-Marx C, Thomas SM, Sterling KL, Olsen CJ, et al. Influence of Treatment Intensification on A1c in Patients with Suboptimally Controlled Type 2 Diabetes After 2 Oral Antidiabetic Agents. J Manag care Spec Pharm. 2019;25(3):314–22. DOI:10.18553/JMCP.2019.25.3.314.
Lee SWH, Chan CKY, Chua SS, Chaiyakunapruk N. Comparative effectiveness of telemedicine strategies on type 2 diabetes management: A systematic review and network meta-analysis. Sci Rep. 2017;7(1):1–11. DOI:10.1038/s41598-017-12987-z.
Paz-Ibarra J, Benites R, Nacional H, Martins ER, Social De Salud S, Lima E. Efecto de un programa de educación diabetológica en pacientes adultos de la consulta ambulatoria en un hospital nacional peruano. An la Fac Med. 2020;81(2):161–6. DOI:10.15381/ ANALES.V81I2.17673.
1.png)
.png){kind=logo}
