Metabolic control in a nationally representative diabetic elderly sample in Costa Rica: patients at community health centers vs. patients at other health care settings

摘要

Background: Costa Rica, like other developing countries, is experiencing an increasing burden ofchronic conditions such as diabetes mellitus (DM), especially among its elderly population. Thisarticle has two goals: (I) to assess the level of metabolic control among the diabetic population age60 years old in Costa Rica, and (2) to test whether diabetic elderly patients of community healthcenters differ from patients in other health care settings in terms of the level of metabolic control.Methods: Data come from the project CRELES, a nationally representative study of people aged60 and over in Costa Rica. This article analyzes a subsample of 542 participants in CRELES with selfreporteddiagnosis of diabetes mellitus. Odds ratios of poor levels of metabolic control at differenthealth care settings are computed using logistic regressions.Results: Lack of metabolic control among elderly diabetic population in Costa Rica is described asfollows: 37% have glycated hemoglobin 7%; 78% have systolic blood pressure > 130 mmHg 66%have diastolic blood pressure 80 mmHg; 48% have triglycerides 150 mg/d1; 78% have LDL 100mg/di; 70% have HDL 40 mgldl. Elevated levels of triglycerides and LDL were higher in patientsof community health centers than in patients of other clinical settings. There were no statisticaldifferences in the other metabolic control indicators across health care settings.Conclusion: Levels of metabolic control among elderly population with DM in Costa Rica are notthat different from those observed in industrialized countries. Elevated levels of triglycerides andLDL at community health centers may indicate problems of dyslipidemia treatment among diabeticpatients; these problems are not observed in other health care settings. The Costa Rican healthcare system should address this problem, given that community health centers constitute a meansof democratizing access to primary health care to underserved and poor areas.