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Diabetes burden is greater in low- middle-income countries, where large gaps exist in achieving diabetes care goals. We examined a quality initiative multicomponent integrated care (MIC) program (DIABEMPIC, DIABetes EMPowerment and Improvement of Care) on diabetes care goals in adults with type 2 diabetes (T2D) implemented in a public primary care specialized diabetes clinic in Mexico City/Iztapalapa. DIABEMPIC is a 5-month empowerment-based program that includes an interdisciplinary case management team, diabetes self-management education, shared medical appointments, a patient-centered approach, and audit and feedback. At the end of the program patients continue routine care in public primary care units. We report the effect of the intervention on diabetes care goals at the end of the program and 18 months after the initial recruitment (long-term evaluation). Results: 704 patients with T2D completed the program, and 182 already have a long-term evaluation. The mean (SD) age of this subgroup was 57 (10.9) years, 67% female, 61% had elementary or less education, 68% had medium-low or lower socioeconomic status, mean diabetes duration was 13 (8) years, and mean A1c was 9.5% (2.2). After the program (n=182) systolic and diastolic blood pressure (-11, -4 mmHg respectively), A1c (-2.6%), and non-HDL cholesterol (-29 mg/dl) decreased significantly (p Disclosure R. Silva-tinoco: None. A. Gallardo-hernández: None. J. Ochoa-moreno: None. V. Delatorre-saldaña: None. T. Cuatecontzi-xochitiotzi: None. A. Gonzalez-cantu: None. C. Castillo-galindo: None. B. Pimentel-hernández: None. M. Romero-ibarguengoitia: None. A. Núñez-rodríguez: None. F. Orozco-gutiérrez: None.

Type 1 diabetes (T1D) is a growing chronic disease. Evidence of whether the healthcare setting affects management and glycemic control is scarce. We evaluate outcomes in patients with T1D in private and public healthcare settings in Mexico, registered in the National T1D Registry in Mexico (RENACED-DT1).Biochemical parameters, diabetes education, and treatment were analyzed considering the data registered in the last visit. Development of chronic complications was determined during follow-up.We included 1,603 patients; 71.5% (n = 1,146) registered in the public system, and 28.5% (n = 457) in a private institution. Patients in the public setting had higher HbA1c (8.6%, IQR: 7.3%-10.5% vs 7.7%, IQR: 7.0%-8.8%; p 0.001). Indicators of diabetes education, glucose monitoring, and use of insulin-pumps were lower in the public setting. Patients in the public setting were at higher risk of diabetic chronic kidney disease, retinopathy, and neuropathy. Diabetes knowledge was a mediator between type of healthcare setting and the likelihood of achieving glycemic control.Patients registered in public healthcare settings have an adverse metabolic profile and higher risk of complications. Social factors need to be addressed in order to implement multidisciplinary measures focused on diabetes education for patients with T1D in Mexico.

In this study, difficulties in coping with diabetes were evaluated during the coronavirus disease 2019 (COVID-19) lock-down Similarly, the change in diabetes self-care activities was evaluated in patients with a recent assessment before COVID-19 lockdown in Mexico City In 212 patients with type 2 diabetes (T2D) and regular primary care, a designed questionnaire was used to evaluate the presence/absence of difficulties in self-care related to diet, physical activity/exercise, glucose monitoring, treatment adherence, getting pharmacological treatment, and confinement adherence The Summary of Diabetes Self-Care Activities tool was used to compare the frequency of self-care behaviors in the past 7 days Self-reported difficulties in coping with T2D were documented and included difficulties in self-care behaviors related to diet (41 6%), physical activity/exercise (40 5%), glucose monitoring (23 7%), getting pharmacological treatment (22 9%), pharmacological treatment adherence (19%), and home-confinement adherence (11 7%) In the group of patients with a recent previous-lockdown evaluation, global self-care behavior decreased from 5 15±0 9 to 4 49 ± 1 02 days/week, p 0 001 Diabetes self-care was a predictor for the presence of difficulties in coping with diabetes Patients with T2D reported difficulties in coping with T2D and decreased diabetes self-care activities during the COVID-19 lockdown in Mexico City Health-care policies must be designed and implemented to attenuate diabetes disease burden caused by this ongoing and future health-contingencies En el presente estudio se evaluaron las dificultades para hacer frente a la diabetes por los pacientes durante el confinamiento por COVID-19 Asi mismo, se evaluo el cambio en las actividades de autocuidado de diabetes en pacientes con evaluacion reciente antes del confinamiento por COVID-19 en la Ciudad de Mexico En 212 pacientes con diabetes tipo 2 (DT2), se utilizo un cuestionario disenado para evaluar la presencia/ausencia de dificultades para el autocuidado La herramienta Summary of Diabetes Self-Care Activities (SDCA) se utilizo para comparar las actividades de autocuidado, reportado en dias a la semana Las dificultades reportadas por los pacientes incluyeron las relacionadas con: alimentacion (41 6%), actividad fisica/ejercicio (40 5%), monitoreo de glucosa (23 7%), acceso al tratamiento farmacologico (22 9%), adherencia al tratamiento farmacologico (19%) y adherencia al confinamiento (11 7%) En el grupo de pacientes con una evaluacion reciente previa al confinamiento, la actividad global de autocuidado disminuyo de 5,15±0,9 a 4,49±1,02 dias/semana, valorp 0,001 El autocuidado en diabetes fue predictor de la presencia de dificultades para hacer frente a la diabetes Los pacientes informaron dificultades para afrontar la diabetes y disminuyeron las actividades de auto-cuidado durante el confinamiento por COVID-19 Politicas de atencion medica deben disenarse e implementarse para atenuar la carga de la enfermedad causado por esta y futuras contingencias en salud

Background. Type 1 Diabetes (T1D) is the most common chronic endocrinological disease diagnosed during childhood. It requires continuous education, monitoring and treatment. An analysis was developed to learn if there were discrepancies in the level of metabolic control and complications between private and public healthcare in Mexico, based on the data obtained in the National Registry of patients with Type 1 Diabetes (RENACED DT1). Objective: Describe the sociodemographic characteristics, metabolic control, treatment and complications in patients receiving private or public health care registered in RENACED DT1.Methodology: Sociodemographic and anthropometric variables, metabolic control, diabetes education, type of insulin and delivery method used for treatment, glucose monitoring and acute and chronic complications were compared between patients receiving private vs public health care. Results Of the 1458 patients registered, significant differences between HbA1c levels were seen (7.8% private health care vs 8.7% public healthcare, p 31.3%, p