Abstract
OBJECTIVE: To investigate whether there is a relationship between the quality of the clinical history (CH) in primary care and metabolic control of patients with diabetes (DM). DESIGN: Retrospective and observational. SETTING: 15 health centres in the Segovia Area. PATIENTS: 315 diabetic patients, selected at random from among those with a record of the type of DM, date and outcome of at least one HbA1c and treatment at the time of the most recent HbA1c. RESULTS: The quality of the clinical histories was measured through the mean of recording of the following items in the 13 months previous to the most recent HbA1c: weight and height, peripheral pulses, sensitivity, foot examination, creatinine, proteinuria, microalbuminuria, glucaemia levels, back of eye, ECG, and diet, tobacco and alcohol counselling. Other variables that could condition the HbA1c, chronic pathologies and those related to DM, were gathered too. Of patients treated with diet or oral diabetic drugs, patients with a clinical history of < or = 49% quality had a mean HbA1c of 7.40%, whereas those with CH of > or = 50% quality had an average of 6.94% (0.46 difference; 95% CI, 0.03-0.90; p = 0.038). This drop was not attributable to age, gender, years of evolution or BMI differences. The risk of having an HbA1c > or = 7.5% is double in patients with a CH of < or = 49% quality than in those with CH of > or = 50% quality (OR = 2.06; 95% CI, 1.14-3.72). In insulin-treated patients, no association between CH quality and HbA1c was found. CONCLUSIONS: Follow-up of the recommendations for clinical action is associated with better metabolic control in diabetics treated with diet--oral diabetic drugs. This association was not found in insulin-treated patients.