Factors Influencing Glycemic Control in Patients with Diabetes Type II in Mexican Patients

Research Article

J Fam Med. 2016; 3(2): 1051.

Factors Influencing Glycemic Control in Patients with Diabetes Type II in Mexican Patients

Ramirez LDH¹, Soto AF¹, Valenzuela CLC¹, Ochoa MC², Gonzalez HR¹ and Lopez MCM³*

¹Department of Family Medicine, Mexican Institute of Social Security (IMSS), Sonora Delegation, Sonora, México

²Regional General Hospital, IMSS, Sonora Delegation, Sonora, México

³IMSSDelegation in Sonora, Sonora, México

*Corresponding author: López-Morales Cruz Mónica, IMSSDelegation in Sonora, Colonia Centro, Cd. Obregon, Sonora, México

Received: February 20, 2016; Accepted: March 15,2016; Published: March 17, 2016


Background: The glycemic control in patients with type 2 diabetes (T2D) is complex and difficult, due to the impact of multiple factors especially family members.

Aim: So the purpose of this study is to know the primary factors that influence glycemic control in patients with T2D.

Design and Setting: Comparative cross-sectional study.

Methods: In 166 patients with T2D in a family medicine unit in Ciudad Obregon, Sonora, Mexico, two groups where formed, the controlledgroup (with a fasting plasma glucose < 130 mg/dL and HbA1c < 7%) and the uncontrolled group (with a fasting plasma glucose = 130 mg/dL and HbA1c = 7%), surveys were conducted in obtaining socio-demographic (age, gender, marital status, schooling, socioeconomic status), clinical (body mass index, nutritional status, timeof diagnosis, use of insulin,number of medications used, history of high blood pressure, treatment adherence and patient physician relation) and family information (typology based upon integration, development, demographics; functionality and family life cycle stage).

Results: Patients in the uncontrolled group presented greater timeof diagnosis, lack of adherence to treatment, use of insulin, a non-satisfactory patient-physician relation, family dysfunction and find themselves prior to the retirement and death phase of the family life cycle.

Conclusion: In the treatment of patients with T2D, it is necessary to consider family and contextual variables to favora better control.

Keywords: Type 2 Diabetes Mellitus; Glycemic control


The family, the nucleus of society, is the main resource of health promotion and disease prevention, as well as the most effective protection that feels and perceives the individual to all changes and contingencies throughout its vital cycle [1]. The family is the first network of social support that the individual possesses, and exerts protective function to the tensions generated in every day the life [2].

Understanding the life cycle and classifying the families of patients with diabetes is an important step to understand the crises and difficulties which the family is going through and how it influences on the glycemic control [3]. The family typology and its functionality are important aspects to consider in a family with patient carrier of T2D; the significance of these classifications is identified mainly in the need of the family physician to identify characteristics of the members of the families that influence the health-disease process, each of the classifications of typology and family functionality affects this process and conditions risk and protective factors for patients with chronic disease [4].

The main goal in the treatment of the patient with diabetes mellitus is to maintain an appropriate metabolic control, normalizing fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) levels to prevent, delay or minimize the development of the late-onset complications [5]. To achieve adequate glycemic control involves a series of factors that have not been studied in depth, which include biological characteristics, socio-economic and familial factors, therefore, it is important to determine the clinical and family factors associated with an adequate glycemic control in patients with T2D.


A comparative cross-sectional study was carried out, in the family medicine unit #1, of the Mexican Institute of Social Security, located in Obregon City, Sonora, Mexico; in patients with T2D, which were selected by a consecutive sampling techniques; that met the following inclusion criteria: age between 20 to 79 years, that accepted and signed the informed consent, in the company of an adult family member, which they lived with; patients with psychiatric illness and chronic renal failure were not included and eliminated those who did not complete the survey.

The following data were obtained directly from the patients: age, gender, marital status, educational stages, socioeconomic level, adherence to treatment, time from onset of T2D (considered the approximate date of diagnosis), insulin use, number of medications used (to determine the existence of polypharmacy, which was considered when the patient consumed 4 or more medications prescribed or not), and history of high blood pressure. The Graffar- Méndez-Castellanos method was used to classify the socio-economic level [6], it was developed in France by Dr. Graffar and adapted by Dr. Hernán Méndez Castellanos, which consists of a stratification of the population from the following five variables: profession of the head of the family, level of instruction of the parents, source of income and housing and neighborhood aspect. From the sum of the variables five strata are identified: high level (stratum I), medium-high level (stratum II), medium level (stratum III), labor (stratum IV) and marginal level (stratum V). The instrument is validated to Spanish with a Cronbach´s alpha of 0.706.

Adherence to treatment was determined by the Morinsky Green test [7], which consists of fourclear and simple questions. This test considers good adhesion to that person who correctly answers the 4 questions made (no, no, no, no). It has 49% sensitivity and 68% specificity; it’s validated in Spanish with a Cronbach´s alpha of 0.617. Doctor-patient relationship was measured by applying the PDRQ-9 questionnaire, consisting of 9 questions with a 5-point Likert-type scale, where: 1= very inappropriate and 5= very appropriate, it´s validated in Spanish with a Cronbach´salpha of 0.95. It is considered a successful physician-patient relationship with a score of 35 and above [8].

The participants long with the family companion were asked about the characteristics of the family based on development, demography, occupation of head of family, kinship and physical presence at home, livelihood, complications of development and conformation (De la Revilla L., the second consensus of Guadalajara in 2008 and currently accepted by the Mexican Council for certification in family medicine [4].

To evaluate family functionality the family Apgar score was used, which was created by Dr. Smilkstein in 1978. It´s a questionnaire that consists of five questions, with three answer options ranging from 0-2 points, validated in Spanish with a Cronbach´s alpha of 0.8010. The vital cycle was based on Geyman´s life cycle, developed by this same author in 1980 [9].

To determine nutritional status, body mass index (BMI) was calculated for which the patients were weighed and measured, on a scale with stadiometer (Transcell technology model TI-540-SL), it was calculated based on the Quetelet index (BMI = weight/talla2).

Glycosylated hemoglobin (HbA1c) and fasting plasma glucose were taken from a sample of venous blood with a fast for at least 8 hours (AU-480 chemistry system), we considered controlled values those who had a plasma glucose fasting (GPA) < 130 mg/dl and HbA1c < % 7.

The data obtained was integrated into data collection sheets and analyzed using the SPSS program version 20 in Spanish, where we applied descriptive statistics for qualitative variables use frequencies and percentages and for quantitative variables mean, median, mode and standard deviation were used. The patients were divided into two groups, controlled and non-controlled considering HbA1c levels. It was considered a p< 0.05, with a 95% confidence interval.

The Protocol was authorized by the Local Committee of Research and Ethics in Health Research from the Family Medicine Unit #1, where the study took place.


We analyzed a sample of 166 patients, of whom 86(51.8%) were women and 80(48.2%) men. The average age was 60.10±10. 59 (28-79) years, the time of diagnosis of the patients was on average 9.18± 6.2 (1-25) years. 146(88%) were married, 65.7% with primary schooling and 59.9% with a worker typesocio-economic level.

Out of the 166 patients, 100(60.2%) suffered from hypertension; 148 (89.2%) consume 4 prescription drugs or more; 88(53%) have proper adherence to treatment, 69(41.6%) use insulin, and 159(95.8%) referred to have a satisfactory patient physician relation.

With respect to glycemic control 72(43.4%) were in adequate control against 94 (56.6%) who weren’t; fasting plasma glucose averaged was 169. 22±75.3 (68-375) mg/dl and HbA1c of 8. 06±2. 29 (4.8-13.10) %. The BMI was an average of 32.10±6.2 (21.9-50.4) kg/ m2.; 96 (57.8%) of patients had obesity, 55(33.1%) were overweight and only 15(9%) were within normal parameters.

Family functionality (APGAR test) presented a median of 8 points (±1.4). Out of a total of 132 families (79.5%) were functional and 34(20.5%) were dysfunctional. We found the following family characteristics: 163(98.2%) were classified have traditional, 164(98.8%) lived in urban areas, 146(88%) were of working-class; 162(97.6%) had a nuclear conformation, 164(98.8%) were integrated families and 119(71.7%) were classified in the retirement and death phase (Geyman).

Groups were classified according to glycemic control and they were statistically significant differences in time of diagnosis 7.54 ± 5.4 (controlled) against 10.4 ± 6.46 (uncontrolled) years (p=0.001), and in the gender variable, women had greater glycemic control 45(62.5%) compared to the men 27(37.5%) p=0.002. The glycemic controlled group showed a smaller proportion of insulin use 12(16.7%) against 57(60.6%) in the glycemic uncontrolled group (p=0.0001), as well as a better attachment to treatment 62(86.1%) vs 26(27.7%) (Controlled vs uncontrolled, p=0. 0001) (Table 1).

Citation:Ramirez LDH, AF Soto, Valenzuela CLC, Ochoa MC, Gonzalez HR and Lopez MCM. Factors Influencing Glycemic Control in Patients with Diabetes Type II in Mexican Patients. J Fam Med. 2016; 3(2): 1051. ISSN: 2380-0658