ABSTRACT
Our objective was to develop a guide based on the best available evidence that allow family physicians to establish criteria for screening, diagnosis, prevention, treatment of disease, early detection and management of complications; to standardize the organizing processes of the diabetic patient's care in the primary care level; and to achieve lifestyle modification for patients and promote self-care. Clinical questions were stated according to the diagram and structured patient-intervention-comparison-outcome. We used a mixed methodology-adoption adjustment, and include 32 guides. For recommendations not included in these, the search process was conducted in PubMed and Cochrane Library Plus with these terms: diabetes mellitus type 2, epidemiology, detection and diagnosis, classification, drug therapy, effects, prevention, control and complication. The clinical practice guideline emphasizes the fundamental change in lifestyle (diet and exercise), self-care and proactive participation of the patient, in addition to the dynamic prescription of medications that would achieve metabolic control in order to reduce late complications.
Subject(s)
Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/therapy , Algorithms , Humans , Practice Guidelines as TopicABSTRACT
The Instituto Mexicano del Seguro Social--always sensitive to the needs of health of the beneficiary population and to the demographic and epidemiological changes of the society--has developed and implemented DiabetlMSS, a program of attention to the diabetic patient. DiabetlMSS organizes care processes based on the needs and values of the patients, through simultaneous activities of individual consultation and group meetings granted by the multidisciplinary health team. These actions and activities are focused to affect patients' lifestyles positively. Through a plan of nutrition, physical activity, self-care and monitoring, this program increases the interaction between patients, by having an exchange of successful experiences about diabetes control. DiabetlMSS was created with the purpose that the patients achieve the metabolic control and identify complications early on, with the perspective of timely intervention that is reflected in the decrease of the catastrophic effects that causes the disease, both for patient's life expectancy and the quality of care provided by the Institute.
Subject(s)
Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/therapy , Academies and Institutes , Humans , MexicoABSTRACT
OBJECTIVE: to evaluate a personalized diet customize for present comorbidity, on metabolic control indicators and renal function. METHODS: a non-randomized clinical trial was conducted during a three-month period in a group of patients with microalbuminuria and in a group with macroalbuminuria. The patients received personalized dietary counseling customize to their comorbidity (obesity, hypertension, and dislypidemia). The effect of the diet was measured through metabolic control variables: body mass index (BMI), waist circumference, fasting glucose levels, glycated hemoglobin (HbA(1))c and lipids profile; the renal function variables were: glomerular filtration rate (GFR) and urine albumin excretion (UAE). Statistical analysis was done with t-paired test. RESULTS: thirty-nine patients were included (21 women and 18 men). After the intervention, the weight and waist circumference had significantly decreased (p = 0.01); the fasting glucose levels and HbA(1)c were significantly lower (p = 0.001). The HDL-cholesterol increased significantly (p = 0.009); UAE decreased significantly in patients with micro and macroalbuminuria; 123.0 +/- 73.4 to 105.3 +/- 61.3 mg/24-h; p = 0.040 and 1482.7 +/- 1200.6 to 1093.5 +/- 601.8 mg/24-h; p = 0.02. The GFR increased in both groups: 68.9 +/- 35.4 to 74.7 +/- 41.6 mL/min, p = 0.04; and 62.2 +/- 26.6 to 68.5 +/- 25.3 mL/min, p = 0.02. CONCLUSIONS: the dietary intervention improved the metabolic control and renal function in type 2 diabetes patients with comorbidity.
