title: Quality of previous diabetes care among patients receiving services at ophthalmology hospitals in Mexico.
abstract: OBJECTIVE
  To survey a large sample of type 2 diabetes mellitus (T2DM) patients in Mexico City to determine if patient experience, access to basic services, treatment, and outcomes differed between those with social security coverage and those without.
  
  
  METHODS
  From 2001-2007 a total of 1 000 individuals with T2DM were surveyed in outpatient clinics of the three largest public ophthalmology hospitals in Mexico City. Patients reported information about their health status and receipt of basic diabetes services, such as laboratory glycemic monitoring and diabetes education. Rates were compared between those with (n = 461) and without (n = 539) social security.
  
  
  RESULTS
  Almost half of the patients (46%) in these public facilities were social security patients that were unable to access other services and had to pay out-of-pocket for care. Half of respondents were originally identified as potentially diabetic based on symptom complaints (51%), including 11% with visual impairment. Most patients (87.9%) reported that their glycemic level was being monitored exclusively via fasting blood glucose testing or random capillary blood glucose tests; only 5.3% reported ever having a glycated hemoglobin test. While nearly all respondents reported an individual physician encounter ever, only 39% reported ever receiving nutrition counseling and only 21% reported attending one or more sessions of diabetes education in their lifetime. Processes of care and outcomes were no different in patients with and those without social security coverage.
  
  
  CONCLUSIONS
  In Mexico, the quality of diabetes care is poor. Despite receiving social security, many patients still have to pay out-of-pocket to access needed care. Without policy changes that address these barriers to comprehensive diabetes management, scientific achievements in diagnosis and pharmacotherapy will have limited impact.
authors.affiliation: Centro Multidisciplinario de Diabetes de la Ciudad de México, Resultados Médicos, Desarrollo e Investigación, Mexico City, Mexico. joelrds.coatlicue@prodigy.net.mx
authors.forename: Joel
authors.initials: J
authors.lastname: Rodríguez-Saldana
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Rosales-Campos
authors.forename: Carmen B
authors.initials: CB
authors.lastname: Rangel León
authors.forename: Laura I
authors.initials: LI
authors.lastname: Vázquez-Rodríguez
authors.forename: Francisco
authors.initials: F
authors.lastname: Martínez-Castro
authors.forename: John D
authors.initials: JD
authors.lastname: Piette
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D003376:Counseling / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D003930:Diabetic Retinopathy / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006306:Health Surveys; D006782:Hospitals, Special / Q000191:economics / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D009885:Ophthalmology; D010353:Patient Education as Topic; D011787:Quality of Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D012943:Social Security / Q000191:economics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin