RESUMEN
La diabetes mellitus es un padecimiento multisistémico que requiere de la vigilancia y el
tratamiento de diferentes variables clínicas. El carácter progresivo de la enfermedad
requiere que constantemente se realicen cambios en la terapéutica para mantener las metas
de control recomendadas. En nuestro país existen pocos estudios que aborden, en la vida
real, estos parámetros y su proyección en el tiempo.
Este estudio retrospectivo y longitudinal tiene por objetivo describir en el mediano plazo el
comportamiento de diferentes variables clínicas, y sus posibles factores asociados, en un
grupo de personas con diabetes mellitus atendidos en un centro de atención primaria de la
ciudad de Aguascalientes.
Se incluyeron 149 individuos con diabetes mellitus que tuviera al menos un seguimiento de
3 años en el centro de atención referido, y al menos 3 visitas en cada uno de los años de
observación. Los individuos han sido sujetos a un protocolo estandarizado de atención de la
diabetes y reciben tratamiento con los recursos terapéuticos proporcionados por el sistema
nacional de salud en México. Las variables analizadas fueron el peso, la presión arterial, los
lípidos plasmáticos, la albuminuria y la filtración glomerular.
En general los pacientes incluidos tienen un tiempo prolongado de enfermedad, y cerca de
la mitad de ellos recibía tratamiento para comorbilidades. El nivel de hemoglobina A1c y la
albuminuria fueron las variables con mayores cambios a lo largo del tiempo. La
intensificación del tratamiento determinó que mayor número de personas alcanzaran las
metas de control propuestas.
Concluimos que la diabetes mellitus es un padecimiento en él que las variables clínicas se
modifican constantemente y requieren ajuste en el tratamiento.
ABSTRACT
Type 2 diabetes is a progressive condition that involves different metabolic and vascular
issues that need to be addressed. Progression means that complex therapeutic interventions
needs to be modified over time to accomplish clinical goals. Few studies in our country
provide an insight in a real-world setting of how different clinical measurements perform
for long period of time.
The main objective in this observational one center study was to assess the performance in
the long-term of certain clinical variables in a sample of individuals with type 2 DM
attending an out-patient diabetes clinic in Aguascalientes, Mexico.
We included 149 subjects diagnosed with diabetes mellitus who had visited the clinic for
medical follow-up for at least 2 times every year for the last 3 years. Variables of interest
were evaluated at each clinic visit in a standardized manner following international
guidelines. Clinical parameters were measured at the last available visit in 2017 and from
there backwards on for the last three years. Results are shown as the mean for all the visits
yearly. The main parameters to be evaluated were weight, blood pressure, lipids, HbA1c,
albuminuria and glomerular filtration rate. Most patients were receiving drug therapy for
glycemic control and metabolic or vascular co-morbidities. Near two thirds of participants
had diabetes for more than 10 years and the average of clinic visits was 3 per year. HbA1c
goal was set on an individual basis and 32% were considered fragile or high-risk profile
and goal was set around 8%. Near half of participants met the treatment target and there
were no differences in the percentage depending on risk profile. Weight, blood pressure and
lipid remain relatively stable along the time, not the case for HbA1c and albuminuria. In
almost two thirds hypoglycemic treatment was intensified. We observed no correlation
among the different variables and improvements in therapeutic goals were mainly
associated to drug treatment intensification. Insulin use grew 62% during the observation
period.
We conclude that glycemic control, albuminuria and renal filtration rate are the most
changing and evasive clinical parameters in diabetes and they need ever changing
treatment.
