Diabetic patient control in Primary Care: Influence of service portfolio and other factors

Objective: To study the effect of the type of follow-up according to Service Portfolio and other associated factors, in the reduction of HbA(1c) levels in people with a new diagnosis of type 2 diabetes and poor initial control. Design: Analytical observational study of a cohort under routine clinical practice conditions. Location: 262 Primary Health Care Centres in Madrid. Participants: 1,838 individuals older than 18 years with a new diagnosis of type 2 DM and initial HbA1c levels >= 7%, or >= 8.5% if older than 75 years. Interventions: The exposure variable was the type of follow-up according to Portfolio, categorised as minimum, medium, and optimal, according to the number of interventions performed and periodicity of type of therapeutic-pharmacological plan. Main measurements: A study was made of the comorbidity, therapeutic-pharmacological plan, diet - exercise advice and deprivation index. The main outcome was the difference between the final and initial HbA1c. Results: After 2 years of follow-up there was a mean decrease in HbA1c by -1.7 percentage points (95% cl: -1.6;-1.8), which was 0.36 points higher in patients with optimal follow-up: -2.1 (95% CI: -1.7;-2.4). The factors associated with a decrease in HbA1c were the optimal follow-up -0.29 (95% CI: -0.5;-0.1), the medium follow-up -0.26 (95% CI: -0.5; -0.0), and the initial HbA1c value -0.9 (95% CI: -0.9; -0.9. The factors associated with the increase were insulin treatment and living in socially disadvantaged areas. Conclusions: Glycaemic control was improved in patients with a new diagnosis of diabetes in which optimal follow-up is performed as proposed in the Service Portfolio. (C) 2020 The Authors. Published by Elsevier Espana, S.L.U.