Abstract

LEON MARTINEZ, Félix; ORDONEZ, Inés Elvira  and  LEON GARCIA, Diego. Defficiencies in the treatment of diabetic patients that ended with renal failure. Acta Med Colomb [online]. 2007, vol.32, n.2, pp.57-67. ISSN 0120-2448.

Objective: assessing if the opportunity and quality of care in patients with type II Diabetes Mellitus in the Health System has some influence in the prevalence and incidence of Terminal Renal Disease and in the events of dialysis therapy at early stages. Design: retrospective study - description of case series. Reference framework: today there is no evidence of what happens with the use of care standards and models of the "EPS" and "ARS" and Public Hospitals, in relationship with chronic and degenerative diseases, such as diabetes mellitus (DM). The growth rate of patients on dialysis therapy due to chronic renal disease reached 15% a year in the last decade. The main cause is diabetes mellitus. It is of crucial importance to detect early on patients with nephropathies and optimize the treatment to delay progression of renal failure, foresee the consequences and decrease associated cardiovascular mortality. We are planning on a study that by means of the analysis of the different existing data, determines the factors that have had an incidence in the progression of chronic renal disease leading to terminal status in patients with DM. Participants: renal patients with diagnosis of type II DM that were admitted between 2002 and 2004to renal clinics; >40 years old and < 65 years, affiliated to an EPS or ARS, or taken care of by supply. Interventions: characterization of the care that the insurance companies provide to patients with Type II DM by means of collection information through surveys and records revision; description and comparison of ERC incidence in diabetic patients affiliated to insurance companies, and the relationship with appropriate and on time care in the early stages of the disease. Measurements: patient’s characteristics and care received before joining the dialysis therapy, participation in a DM program and access to the required services. Analysis of frequency of the variables; and comparison among the different regimes. New codification of variables according relevant criteria and implementation of the values scale according to positive results, in 17 of them, to explain the quality of care in each regime. Results: there is evidence of serious deficiencies in the quality and integrality of care of diabetic patients that were admitted in the dialysis therapy, with results that are matter of concern in all the variables that were analyzed and that were related to therapeutic activities considered to be indispensable in the international literature, for an adequate treatment. The time between the diagnosis of DM and the development of CRI is no more than 13 years. The literature says that the time before initial renal failure is between 20 and 30 years. Dialysis treatment starts only 0.5 years after the diagnosis of renal disease is made and one could assume that this is a late diagnosis and that patients only have access to diagnosis when the deterioration and renal damage are irreversible and rapidly progressive. Conclusions and recommendations: given that this is a descriptive study, it provides information for stating a hypothesis: • There is a direct relationship between the affiliation regime and the quality of care that diabetic patients receive. • The diagnosis CRI in diabetic patients is made very late and the time that it takes to dialysis is very short. • The quality of care of the diabetic patient admitted to dialysis is different than that provided to those that do not require dialysis. • The programs for managing diabetes are weak and do not count on the elements to guarantee good results. • Diabetic patients are not sent to the nephrologists on a regular basis. Multiple studies have demonstrated that an appropriate control of diabetes and early diagnosis of alterations in glomerular filtration lead to take the necessary kidney protecting measures that delay or eliminate the progress of terminal renal disease. This is to call upon de attention of the Health General Social Security System Management, responsible of facing diabetes as a public health issue, taking into account a progressively more urban, sedentary and aging population, and the increased rate of CRI, as a consequence of not having integral and quality care for diabetic patients, with adverse results for the quality of life of the people and for the systems in terms of costs.

Keywords : diabetes mellitus; insuficiencia renal crónica; tratamiento; aseguradora; seguridad social.

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