Track 5. Diabetes Care Organisation & Economics s403

vs. 6,67%; p.cO,OOOl). Contrary in the control-group the greatest decrease Mexican Registry of Diabetes. Each patient receives baseline examina-

(-0.54) was found in the group of the elder (> 65 y.) type 2-patients (7,17 tion, and structured management at each visit (evaluation, therapy, goals), vs. 6,638; p < 0,001). The occurrence of severe hypoglycemic episodes with a team approach instead of the vertical doctor patient interaction. in the elderly type 2-patients was 0,06/patient!yearin the SDM-Group and Diagnostic, therapeutic resources are those available and affordable for 0,16/patient/year in the control-group. As an important second-line effect participating physicians and patients, in addition to a high consideration on the satisfaction of therapy (+43 vs. -12) and the quality of life (+12 vs. organizational issues (reduced waiting time, more interactive interviews -6) increased during 6 months in type 2-patients treated with help of the at the medical office, patient empowerment). Clinical data are recorded SDM-guidelines (both measured with the Bradley questionnaire). Since at each consecutive visit, and therapeutic assignement is based on type Ott 1998 the 55 SDM-trainers instructed more than 260 medical doctors of diabetes, blood glucose leveles, overweight, obesity (especially in in Hamburg in the use of SDM-Decisionpaths. It is planned to enrol a individuals with type 2), acute symptoms, and additional cardiovascular total number of 450 medical doctors. risk factors Conclusions: The controlled study, part of the SDM-project in Hamburg, revealed a significant improvement of glycemic control, an increase in the safety of therapy and the quality of life especially in type 2-patients. The successful implementation of SDM in Hamburg is demonstrated by the fact that in 18 months more than half of the target group has been trained in the application of SDM.

Results: 3,243 patients have been enrolled in the Registry, 1,241 males, and 2,002 females. Fasting blood glucose (FBG) at consecutive visits and changes in therapy are as follows:

Table I. Changes in FBG by visit

P1566 Successful Implementation of an Annual Health Check To Detect Diabetic Complications into Ambulatory Care - The Volkswagen Diabetes Project MONIKA GRUESSER ‘, Viktor Joergens’, Carola Hoffstadt ‘, Petra Hartmann’. ’ Central Research Institute, Cologne, Germany; z Dept. for Metabolic Diseases, H&rich Heine University, Duesseldorf; Germany: 3 Volkswagen Health Insurance, Wolfsburg, Germany

Visit FBG

BaS&tE 221.2ztl13.8

2 177.6i79.5

3 158.Oi71.8

4 151.6zt58.3

5 152.2i69.9

Table 2. Therapy baseline and at follow-up visits

An annual health check for people with diabetes should insure the early detection of diabetic complications. The quality of these examinations is known to be poor in routine care. Therefore in a model project an annual examination for diabetic complications was introduced in the city of Wolfsburg by the Volkswagen health insurance (60,800 insured persons) including an additional remuneration of 35 Euro for the documentation of results by the physicians. The patients receive a copy of the results and agreed to the evaluation of the data. From Nov. 97 to Dec. 99 2.346 people with diabetes were screened for diabetic complications by family physicians. Results: Age 65.7f13 years, 48% female, lOf8 years since diagno- sis of diabetes, BMI 524 in 16%, 25-30 in 52 %, ~30 in 31.6%, HbAlc 7.6f2%. In 12% the examination with the Semmes Weinstein Monofilament was pathologic, 36 patients had plantar ulcers (1.6%). 42 amputations (2%). 247 patients had RR values of >I60 syst and 295 mmHg diast.! According to the recent WHO classification only 4.2% of the patients had optimal (<120/80), 12.6% ideal (x130/85 mmHg. Conclusions: The financial incentive resulted in a successful implementa- tion of screening for diabetic complications into primary care and provided population based data on the prevalence of diabetic complications. Baaed upon the data, the quality of the treatment of hypertension must be improved substantially.

Intervention

Diet

Metfomin

Sulphmylurea

AmboSe

Insulin

Combination, oral

No therapy

Baseline (%) Current (5%)

37.0 99.7

4.8 9.0

47.5 34.6

1.8 0.8

14.2 27.3

19.9 25.7

II.6 0

Conclusions: The result of the program document that improvements in quality of ambulatory diabetes care are feasible in Mexico. The majority of the patients are treated at centers with very limited resources, that have traditionally relied on referral to secondary/tertiary care centers for usual diabetes care, with the ensuing direct/indirect costs for individuals and institutions. Economic and material resources, albeit desirable, have not been essential to improve clinical outcomes. Basic information on diabetes is neither required, by comparison to identifying individual physi- cians/institutions with everyday compromise ability to make organization adjustments in primary care delivery, implementation, adaptation and observance of clinical guidelines.

P1568

P1567 Staged Diabetes Management (SDM) in Mexico: 4 Year Follow-Up JOEL S. RODRfGUEZ, Roger S. Mazze, Donnell Etzwiller, Reyna P Nhiiez, Edilberto A. Meza, Etsuo E.H. Tirado, Enrique E. Bemal, Jose U. Rodriguez, Jose L.P Hematrdez, Marco A.M. Garcia, Eduardo N. CNZ. Mexican Registry of Diabetes (Re&MeDi), Mexico; International Diabetes Center ([DC), Minneapolis, MN, United States of America

Diabetes Care in Mexico: Diagnosis, Cardiovascular Risk Factores and Complications JOEL S. RODRfGUEZ, Reyna P Nuiiez, Jose L.P. Hem&rdez, Juan J.R. Espinosa, Guadalupe F. Morales, Jose U. Rodriguez, Emique E. Bernal, Etsuo E.H. Tirado, Fernando C. Ramos, Edilberto A. Meza, Graciela R. Alexanderson, Marco A.M. Garcia, Eduardo N. Cruz, Ricardo R. Alvsrado. Mexican Registry of Diabetes Re&MeDi, Mexico

Objective: To investigate the efficacy of a structured program of ambu- latory diabetes care on blood glucose levels, and the use of therapeutic resources. Patients and methods: Males and females with Type 1 and Type 2 diabetes mellitus, treated by participating physicians and centers of the

Objective: To investigate the clinical conditions of mexican patients with diabetes at the initial visit, including age, blood glucose levels, cardiovascular risk factors and macro/microvascular complications. Rationale: Albeit early diagnosis and therapy of diabetes is a worldwide recommendation, available data have documented delays in diagnosis, associated with the level of hyperglycemia and complications. Patients and methods: Patients included in the Mexican Registry of Diabetes receive a survey at the initial visit by participating physi- cians/institutions, in which demographic, clinical, laboratory and thera- peutic information is collected, for baseline analysis. Eligible participants are males and females with type 1, type 2 and gestational diabetes from