title: Trends in chronic complications of type 2 diabetic patients from Spanish primary health care centres (GEDAPS study): ten year-implementation of St. Vincent recommendations.
abstract: OBJECTIVE
  To assess the implementation of St. Vincent recommendations in Catalonia (Spain) between 1993 and 2003 following a program of Continuous Quality Improvement.
  
  
  METHODS
  65 health centres (433 health professionals) took part in the study. From 1993 to 2003, 34 workshops on consensus guidelines and feedback referring to the variables that needed to be improved were carried out. Data collection was obtained concerning, socio-demographic information, and disease characteristics and complications from patients with type 2 diabetes mellitus (DM).
  
  
  RESULTS
  Most cardiovascular risk factors improved: glycosilated haemoglobin (HbA1c) was reduced by 0.7% (95% CI: -0.49:-0.90); total cholesterol by 0.54mmol/L (95% CI: -0.53:-0.55); non-high density lipoprotein cholesterol by 0.81mmol/L (95% CI: -0.80:-0.82); systolic blood pressure (SBP) by 6.02mmHg (95% CI: -5.79:-6.25), and diastolic blood pressure (DBP) by 2.65mmHg (95% CI: -2.4:-2.9), with the exception of smoking and obesity, which increased by 2.1% and 5.9%, respectively. Retinopathy and albuminuria decreased by 40.7% and 46% (p<0.001), respectively. The incidence of diabetic foot lesions and amputations decreased by 65.7% and 61.1% (p<0.001), respectively. The prevalence of macrovascular complications showed a slight reduction (p=0.037). Ischemic cardiomyopathy and cerebrovascular accidents decreased by 7.7% and 17.6%, respectively.
  
  
  CONCLUSIONS
  Our Continuous Quality Improvement program based on St. Vincent recommendations, had a positive impact on cardiovascular risk factors. We observed a reduction of chronic complications in type 2 DM patients.
authors.affiliation: University Public Health Center El Carmel-Barcelona, Department of Medicine, Universitat Autònoma de Barcelona, Unitat de Suport a laRecerca Barcelona Ciutat – IDIAP Jordi Gol, Institut Català de la Salut, c/ St Elies 42 Barcelona, Spain. Xavier.Mundet@uab.cat
authors.forename: Xavier
authors.initials: X
authors.lastname: Mundet
authors.forename: Francisco
authors.initials: F
authors.lastname: Cano
authors.forename: Manel
authors.initials: M
authors.lastname: Mata-Cases
authors.forename: Pilar
authors.initials: P
authors.lastname: Roura
authors.forename: Josep
authors.initials: J
authors.lastname: Franch
authors.forename: Martí
authors.initials: M
authors.lastname: Birules
authors.forename: Rosa
authors.initials: R
authors.lastname: Gimbert
authors.forename: Judith
authors.initials: J
authors.lastname: Llusa
authors.forename: Xavier
authors.initials: X
authors.lastname: Cos
mesh_terms: D000368:Aged; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000628:therapy; D002908:Chronic Disease; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009313:National Health Programs / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D015995:Prevalence; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology