title: Quality of Diabetes Care: The Challenges of an Increasing Epidemic in Mexico. Results from Two National Health Surveys (2006 and 2012).
abstract: BACKGROUND
  The quality of diabetes care remains suboptimal according to numerous studies assessing the achievement of quality indicators for diabetes care in various healthcare settings. We report about global and specific quality indicators for diabetes care and their association to glycemic control at the population level in two national health surveys in Mexico.
  
  
  METHODS
  We conducted a cross-sectional analysis of the 2006 and 2012 National Health Surveys in Mexico. We examined quality of care for 2,965 and 4,483 adults (≥ 20 years) with diagnosed type 2 diabetes using fourteen simple and two composite indicators derived from self-reported information. In a subsample for both surveys, glycated hemoglobin (HbA1c) was measured at the time of the interview. We obtained survey weight-adjusted estimators using multiple regression models (logistic and linear) with combined data files, including survey year as covariate to assess change.
  
  
  RESULTS
  Global quality of care in 2012 was 40.8%, with a relative improvement of 11.7% between 2006 and 2012. Detections of cardiovascular disease risk factors (dyslipidemia and hypertension) were the indicators with the highest improvement, while non-pharmaceutical treatment and diabetic foot exams showed minor changes. We found a significant association between the quality of the process of diabetes care and glycemic control (OR 2.53, 95% CI 1.63-3.94). Age more than 65 years old, the type of health subsystem, gender (males), and high socio-economic status were also significantly associated to glycemic control.
  
  
  CONCLUSIONS
  Quality diabetes care and glycemic control improved and are significantly associated. However, according to international standards, the current situation remains suboptimal. A more holistic approach is needed, with an emphasis on improving quality in outpatient care.
authors.affiliation: Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Sergio
authors.initials: S
authors.lastname: Flores-Hernández
authors.affiliation: Dirección del Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: Saturno-Hernández
authors.affiliation: Dirección de Investigación, Hospital Infantil de México "Federico Gómez", México, Distrito Federal; México.
authors.forename: Hortensia
authors.initials: H
authors.lastname: Reyes-Morales
authors.affiliation: Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Tonatiuh
authors.initials: T
authors.lastname: Barrientos-Gutiérrez
authors.affiliation: Centro de Investigación en Salud y Nutrición, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Salvador
authors.initials: S
authors.lastname: Villalpando
authors.affiliation: Dirección General, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Hernández-Ávila
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008800:Mexico / Q000453:epidemiology; D011787:Quality of Health Care
chemical_list: D001786:Blood Glucose