title: [Poor metabolic control in primary care].
abstract: BACKGROUND
  Poor metabolic control is a constant in patients with diabetes worldwide, despite resources demonstrated to achieve therapeutic targets. The object of this study was to identify causes of poor metabolic control in patients with diabetes treated in Family Medicine Clinics in metropolitan Mexico City at the Instituto Mexicano del Seguro Social.
  
  
  METHODS
  We analyzed 638 of 1,170 patients studied between 2000 and 2006. Anthropometric variables, occurrence of infections, treatment adherence, medical prescriptions, diet, exercise, and laboratory results were recorded.
  
  
  RESULTS
  The proportion of patients with HbA1c < 7% worsened over time: from 38.9% at baseline it decreased to 21.4% (p < 0.001); LDL cholesterol decreased from 51.9 to 12.2% (p < 0.001), and controlled blood pressure from 35.6 to 23.3% (p < 0.001). A diet high in calories was associated with poor metabolic control (OR: 2.36; 95% CI: 1.34-4.13) and treatment intensification with elevated HbA1c (OR: 2.1; 95% CI: 1.14-4.14). Treatment was not intensified in 90% of patients outside targets. Infections, non-adherence, and drugs that interfere with oral hypoglycemic agents were not associated with higher HbA1c.
  
  
  CONCLUSIONS
  The main factors associated with higher HbA1c were: disease progression, an inadequate diet, and lack of treatment intensification. Any program designed to improve the conditions of these patients must consider these factors.
authors.affiliation: Unidad de Investigación en Epidemiología Clínica, UMAE Hospital de Especialidades, CMN Siglo XXI, IMSS, Ciudad de México, México.
authors.forename: Niels H
authors.initials: NH
authors.lastname: Wacher
authors.affiliation: Unidad de Investigación en Epidemiología Clínica, UMAE Hospital de Especialidades, CMN Siglo XXI, IMSS, Ciudad de México, México.
authors.forename: Mara
authors.initials: M
authors.lastname: Silva
authors.affiliation: Unidad de Investigación en Epidemiología Clínica, UMAE Hospital de Especialidades, CMN Siglo XXI, IMSS, Ciudad de México, México.
authors.forename: Leticia
authors.initials: L
authors.lastname: Valdez
authors.affiliation: Unidad de Investigación en Bioquímica, UMAE Hospital de Especialidades, CMN Siglo XXI, IMSS, Ciudad de México, México.
authors.forename: Miguel
authors.initials: M
authors.lastname: Cruz
authors.affiliation: Unidad de Investigación en Epidemiología Clínica, UMAE Hospital de Especialidades, CMN Siglo XXI, IMSS, Ciudad de México, México.
authors.forename: Rita A
authors.initials: RA
authors.lastname: Gómez-Díaz
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D008078:Cholesterol, LDL / Q000097:blood; D003920:Diabetes Mellitus / Q000503:physiopathology* / Q000628:therapy; D004032:Diet; D018450:Disease Progression; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D008297:Male; D008800:Mexico; D008875:Middle Aged; D010349:Patient Compliance; D011320:Primary Health Care; D012307:Risk Factors
chemical_list: D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents