Care for the diabetic patient in Catalonia. A study of a population sample

BACKGROUND: The aim of this study was to determine the clinical and therapeutic profile of both types of diabetics (IDDM and NIDDM) attended at different levels of health care in Cataluna in order to establish quality control and rationalize diabetologic sanitary planning. METHODS: Fifteen centers in Cataluna participated in a study with a total of 1,430 patients. The centers represented different specialized care levels: 6 endocrinology public health out-patient clinics (EO), 4 county hospitals (CH), 3 university hospitals (UH) and 2 private diabetic units (DU). RESULTS: IDDM: a) the percentage was higher in UH and DU (39 and 37) than in CH (26 p less than 0.01) and EO (11 p less than 0.001); b) the youngest were attended in UH (24 +/- 14 years) and the oldest in the EO (39 +/- 17 years, p less than 0.001), occupying the CH and DU at an intermediate position (34 +/- 16 and 32 +/- 17 years) and different than the other two (p less than 0.05); c) 74% of those attended in UH had an evolution of less than 10 years vs 45-58% of the other levels (p less than 0.005); d) no differences were observed in the overall prevalence of complications; e) 37% of the males between 15 and 64 years of age were smokers; f) intensive insulin therapy is more frequently used (p less than 0.05) in DU and UH (56% and 42%) than in EO and CH (19% and 13%); g) the determination of capillary glycemia is generalized (96%); h) 14% had HbA1 or fructosamine lower than the maximum normal value. NIDDM: a) the age of the patients was somewhat lower in DU (59 +/- 11) and UH (58 +/- 11) than in CH (62 +/- 100 and EO (64 +/- 10 (p less than 0.05); b) globally, the rate of insulinization was 55% and home control of glycemia was 43%; c) 47% are hypertense (half of whom are inadequately controlled) and 55% are dyslipemic; d) between 15 and 64 years of age 39% of the males are smokers; e) 27% had HbA1 or fructosamine lower than the maximum normal value. CONCLUSIONS: a) The quality of medical care to diabetics in the centers analyzed is high; b) there is no "patient-type" for level of health care; c) there seems to be more therapeutic "aggressivity" among the health care workers responsible for diabetics in relation to the glucose vs other risk factors.