Abstract

LACLE MURRAY, Adriana  and  JIMENEZ-NAVARRETE, Manuel Francisco. Calidad del control glicémico según la hemoglobina glicosilada vs la glicemia en ayunas: análisis en una población urbana y otra rural de diabéticos costarricenses. Acta méd. costarric [online]. 2004, vol.46, n.3, pp.139-144. ISSN 0001-6002.

Introduction: Glycosilated hemoglobin (HbA1c) is at present the best available test to reflect the metabolic control of diabetic patients, however its use is not yet systematic in our national health system. Objective: To determine the quality of metabolic control of Costa Rican diabetics by urbanization level, according to fasting blood glucose or HbA1c and to compare their respective equivalent values. Study design and methods: Retrospective study comparing the two parameters mentioned above, 237 diabetics controlled at 6 Primary Health Care centers (EBAIS) of an urban Health Area (Desamparados, one county of the San José province), and 257 diabetics controlled in 3 Primary Health Care Centers (EBAIS) of a rural Health Area, (Nicoya, one county of the province of Guanacaste), during the year 2000. In the patients of Desamparados the blood glucose closest to the month of July of 2000 and its respective HbA1c, taken the same day, was registered. In those diabetics from Nicoya the average blood glucose and HbA1c of the year 2000 was used for the study. Results: Fasting blood glucose in the urban diabetics was more frequently at higher levels: 35% >200 mg/dl, 20.5% between 141-180 mg/dl and only 17.9% were within normal ranges (60-110 mg/dl), thus exhibiting poor metabolic control. Diabetics from the rural area had similar results, with 27% over 200mg/dl, 22.9% in the ranges of 141-180 and 22.3% within normal ranges. The HbA1c results were not adequate either, at the urban setting, 34.6% were over the critical values of 9.5%, and only 21.1% were lower than 6.5%, compared to 40.4% and 14.0%, respectively in the rural area. When the equivalent ranges of fasting blood glucose were compared with HbA1c, big differences were found; for normal glycemic ranges (60-110mg/dl), on1y 58.5% of the urban data, and 65.3% of the rurals, coincided with its equivalent of HbA1c (<6.5%); 30% of the urban patients and 37% rural patients had for this same values, HbA1c over 8%. When the values of blood glucose were over 200 mg/dl, the relation with its HbA1c equivalent range (> 9.5%) was high: 75.6% in urban area and 82.9 % in the rural area. Conclusion: glycosilated hemoglobin is the best method to evaluate the quality of metabolic control in diabetic patients, especially in those that handle fasting levels <200 mg/dl. In Costa Rica glycosilated hemoglobin determination has not been generalized at primary health level and too many patients are not receiving the benefit of an intensive therapy, because they are being evaluated only with fasting blood glucose. The implementation of glycosilated hemoglobin is posible for our national health system and it should be compulsory in all Health Areas of Costa Rica.

Keywords : Diabetes mellitus; hemoglobina glicosilada; control glicémico; glicemia en ayunas.