The level of metabolic control in low income Mexico City diabetics. The Mexico City diabetes study

RESUMO

The importance of good metabolic control in the treatment of diabetes mellitus (DM) is unquestionable. Measurements of the level control (LC) are available such as glycohemoglobin (GH) and fructosamine (FA). The aims of this study are to estimate LC in a population based case series of type II DM patients, to assess the effect of clinical, metabolic and sociodemographic variables usually associated with the LC and to estimate the clinical impact of the LC on vascular complications of DM. A low income area of Mexico City was enumerated. All males and non-pregnant females between 35-64 years of age were considered eligible. Home interview was obtained in 2813 and a medical exam incluiding an oral glucose tolerance test was performed in 2282 (65.1 per cent). Three hundred and four subjects met the criteria (WHO) for DM. Three years later, 213 (70.1 per cent) were located for GH and FA measurements. Cases were divided according to the level of GH Group I, good LC (GH < o = 8.6 per cent, n = 66); and group II poor LC (GH > o = 8.7 per cent, n = 147). A significant difference was observed in the mean vallue of FA between groups (Grop I 255 ñ 52.3 µmol/dl. Group II 306.4 ñ 51.1; p < 0.001). In compariso with subjects with good LC, patients with poor LC had higher values of duration of DM (p < 0.01), waist/hip ratio (p < 0.04), fasting glucose (p < 0.001) and lower values of fassting insulin (p < 0.07), LDL cholesterol (p < 0.006) and VLDL cholesterol (p < 0.09). Patinets with good LC had less diabetic retinophaty (p < 0.03). Around 48-69 per cent of type II urban Mexican diabetic population have poor LC. Variables usuallyt thougth to affect or be associated with LC do not influence th eend result. New therapeutic strategies in the management of DM are needed to reduce the long-term complications associated with DM