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

Abstract

BACKGROUND: 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 specific quality indicators for diabetes care their association to glycemic control at the population level in two national health surveys in Mexico. METHODS: We conducted a cross sectional analysis of the 2006 2012 National Health Surveys in Mexico. We examined quality of care for 2,965 4,483 adults (≥ 20 years) with diagnosed type 2 diabetes using fourteen simple 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 linear) with combined data files, including survey year as covariate to assess change. RESULTS: Global quality of care in 2012 was 40.8%, with a relative improvement of 11.7% between 2006 2012. Detections of cardiovascular disease risk factors (dyslipidemia hypertension) were the indicators with the highest improvement, while non pharmaceutical treatment diabetic foot exams showed minor changes. We found a significant association between the quality of the process of diabetes care glycemic control (OR 2.53, 95% CI 1.63 3.94). Age more than 65 years old, the type of health subsystem, gender (males), high socio economic status were also significantly associated to glycemic control. CONCLUSIONS: Quality diabetes care glycemic control improved 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.