NATIONAL UNIVERSITY OF THE EAST

PHYSIOTHERAPY AND KINESIOLOGY CAREER

CLINICAL-EPIDEMIOLOGICAL BEHAVIOR OF DIABETES

MELLITUS, IN PATIENTS ATTENDED IN CONSULTATION
EXTERNAL, IN THE HEALTH CENTER “LA SAGRADA FAMILIA
DEL LA FLORESTA NEIGHBORHOOD IN THE CITY OF MONTERO”

PRESENTS:
JESSICA ECHAG ü E QUIROZ
TEACHER:
LIC. ALEJANDRO PIZARRO

MONTERO, DECEMBER 2018

 Clinical-epidemiological behavior of Diabetes Mellitus, in patients treated in
external consultation, at the Sagrada Familia Health Center in the La Floresta neighborhood, during 2018

I. GRATITUDE.

First of all, to God for allowing me to reach this point and for giving me health, being the
source of life and giving me what I need to move forward day by day to achieve my goals,
in addition to his infinite kindness and love.

Secondly, to my family, my husband and my children who have been a fundamental part of
writing this work, they are the ones who give me great lessons and the main protagonists of
this dream that I want to achieve.

II. DEDICATION.

I dedicate this research work mainly to God, for being the inspiration and giving us strength
to continue in this process of obtaining one of the most desired desires.

This work is dedicated to my family for being my support to achieve my goals and
purposes throughout my life and to all the special people who accompanied me in this
stage, contributing to my training both professionally and as a human being.

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 Clinical-epidemiological behavior of Diabetes Mellitus, in patients treated in
external consultation, at the Sagrada Familia Health Center in the La Floresta neighborhood, during 2018

INDEX

I. GRATITUDE..................................................................................................................1
II. DEDICATION.................................................................................................................1
1. INTRODUCTION...........................................................................................................2
2. JUSTIFICATION............................................................................................................3
3. PROBLEM STATEMENT..............................................................................................4
4. GOALS............................................................................................................................5
5. FRAMEWORK...............................................................................................................5
6. METHODOLOGICAL DESIGN....................................................................................8
7. CONCLUSIONS...........................................................................................................14
8. RECOMMENDATIONS...............................................................................................14
9. BIBLIOGRAPHY..........................................................................................................15
10. APPENDICES AND ANNEXES..............................................................................17

1. INTRODUCTION.

Diabetes Mellitus (DM) constitutes one of the main public health problems in the world
due to its high prevalence, given that it can affect people of any age, sex, social class and
geographical area, as well as its high morbidity and mortality and
health cost. Both type 1 Diabetes (DM1) and type 2 cause hyperglycemia,
which can cause chronic macro- and microvascular complications 1 .

The Diabetes Atlas of the International Federation 2013, makes estimates on data
current behavior of Diabetes Mellitus and forecasts for 2030.

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 Clinical-epidemiological behavior of Diabetes Mellitus, in patients treated in
external consultation, at the Sagrada Familia Health Center in the La Floresta neighborhood, during 2018

New figures estimated that in 2013 there were 382 million people with Diabetes in the
world.
world and that this figure will increase to 592 million by 2035, with the countries
low and middle income, those who face an increase in this condition 2 .

In the last 10-20 years, the worldwide prevalence of type 2 diabetes has increased
important way in children and adolescents. Some of the factors responsible for this global
epidemic are overweight and obesity. Multiple environmental and genetic factors have also
been identified. It is estimated that the prevalence of type 2 Diabetes in children and
adolescents is 0.2 to 5%, having increased 10 times over the last decades.

A study carried out by the National Health and Nutrition Program (NHANES III) analyzed
an American population between 12 and 19 years of age and reported a prevalence of 4.1
cases per 1,000 adolescents with type 2 Diabetes (T2DM) 3 .

In Bolivia, more than 70,000 new diabetes patients are reported each year, due to poor
eating habits, sedentary lifestyle and lack of exercise, according to the person in charge of
the National Non-Communicable Diseases Program of the Ministry of Health 9 .

2. JUSTIFICATION.

In the world there are 490,100 children under 14 years of age with type 1 Diabetes and
77,800 new cases are diagnosed each year. Type 1 Diabetes, one of the most common
chronic diseases in childhood, has been increasing in number. Years ago, the majority of
children were diagnosed with Type 1 Diabetes, while Type 2 Diabetes Mellitus prevailed in
adults and the elderly. However, in the last 10-20 years, an alarming increase in the
prevalence of Diabetes has been observed. Type 2 mellitus (T2DM) in pediatric Diabetes
centers around the world 3 .

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 Clinical-epidemiological behavior of Diabetes Mellitus, in patients treated in
external consultation, at the Sagrada Familia Health Center in the La Floresta neighborhood, during 2018

The present study aims to describe the clinical and epidemiological behavior of
Diabetes in the general population, in order to improve the early detection of this
pathology, as well as their care, avoiding its complications, in addition to the study
being able to serve as a source. of information for its reproducibility and preparation
of intervention measures in prevention at the Municipal and National level, as well as
in different posts and health centers, thus making known the groups with the highest
risk, making early diagnoses, avoiding the morbidity and mortality caused by this
disease.

3. PROBLEM STATEMENT.

Diabetes in patients of different ages has been identified as a global problem that has been
complicated by several environmental and genetic factors. Type 2 Diabetes was historically
considered a rare disease in the child and adolescent population; today it occurs at an early
age linked to increase in obesity, which is becoming an epidemic pediatric disease 3 .

"In 2017 we have reported 372,162 cases with diabetes in all its forms in Bolivia, while in
2016 we have reported 294,369 cases and in 2015 215,995 cases were registered," he said
regarding World Diabetes Day 20 (Katherine Bustinza of the Ministry of Health ).

In the City of Montero there are not enough studies on the behavior of this disease in
patients of different ages, therefore, to improve the quality of care and understanding of this
pathology, it is considered important to raise the following problem:

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 Clinical-epidemiological behavior of Diabetes Mellitus, in patients treated in
external consultation, at the Sagrada Familia Health Center in the La Floresta neighborhood, during 2018

What is the clinical and epidemiological behavior of Diabetes Mellitus in patients of

different ages treated in the outpatient clinic, La Sagrada Familia Health Center in
the La Floresta neighborhood of Ciudad Montero during the 2018 administration?

4. GOALS.

4.1. GENERAL OBJECTIVE.

To describe the clinical-epidemiological behavior of Diabetes Mellitus in patients treated in

outpatient clinics, who attend the La Sagrada Familia Health Center, during the 2018
administration.

4.2. SPECIFIC OBJECTIVES.

• Establish the sociodemographic characteristics of the study population.

• Know the personal pathological, non-pathological and family history of patients with
Diabetes Mellitus.
• Determine the nutritional status of patients treated in the outpatient clinic of the Medical
Center.
• Mention the clinical characteristics in the study sample.

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 Clinical-epidemiological behavior of Diabetes Mellitus, in patients treated in
external consultation, at the Sagrada Familia Health Center in the La Floresta neighborhood, during 2018

• Identify complications in the patients sampled in this study.

5. FRAMEWORK.

5.1. THEORETICAL FRAMEWORK.

Diabetes Mellitus is a metabolic disorder of multiple etiologies, characterized by chronic

hyperglycemia and disturbances in the metabolism of carbohydrates, fats and proteins,
resulting from defects in the secretion and/or action of insulin 4 .

The chronic hyperglycemia of Diabetes is associated with long-term damage, dysfunction

and multi-organ failure, especially of the eyes, kidneys, nerves, heart and blood vessels.
Several pathogenic processes are involved in the development of the disease, from
autoimmune destruction of pancreatic β cells with consequent insulin deficiency to
abnormalities that cause resistance to insulin action. The poor action of insulin comes from
its inadequate secretion and/or the decrease in

the response of tissues to insulin at one or more points in the complex pathway of hormonal
action 5 .

5.2. EPIDEMIOLOGY.

The Prevalence of Diabetes Mellitus, the most common form of which is Type 2 Diabetes
(T2DM), has reached epidemic proportions during the first years of the 21st century. It is
estimated that its prevalence will increase from 285 million people in 2010 to 438 million
in 2030, which translates into a 54% increase. This increase in prevalence runs parallel to
the global increase in obesity. The other change that has recently appeared in different
publications is the increase in the prevalence of Type 2 Diabetes in obese children and

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 Clinical-epidemiological behavior of Diabetes Mellitus, in patients treated in
external consultation, at the Sagrada Familia Health Center in the La Floresta neighborhood, during 2018

adolescents, children of African-Americans and Hispanics; It is estimated that annually

about 76,000 children under 15 years of age develop type 1 Diabetes in the world and the
total number of children with type 1 Diabetes is approximately 480,000 6 .

In Bolivia, more than 70,000 new diabetes patients are reported, due to poor eating habits,
sedentary lifestyle and lack of exercise, according to the person in charge of the National
Non-Communicable Diseases Program of the Ministry of Health 9 .

5.3. CLASSIFICATION.

There are various ways to classify Diabetes Mellitus today; currently, in 2014, the
American Diabetes Association (ADA) presented a classification based on the etiological
aspect and the pathophysiological characteristics of the disease 7 .
Understanding like this:

 Type 1 diabetes (DM1): Its distinctive characteristic is the autoimmune destruction

of the ß cell, which causes absolute insulin deficiency and a tendency to
ketoacidosis. Such destruction in a high percentage is mediated by the immune
system, which can be evidenced by the determination of antibodies.
 Type 2 diabetes (T2DM): It is the most common form and is often associated with
obesity or increased visceral fat. Ketoacidosis very rarely occurs spontaneously. The
defect ranges from a predominant resistance to insulin, accompanied by a relative
deficiency of the hormone, to a progressive defect in its secretion.
 Gestational Diabetes Mellitus (GDM): Specifically groups glucose intolerance
detected for the first time during pregnancy.
 Other specific types of Diabetes: such as genetic defects in beta cell function or
insulin action, diseases of the exocrine pancreas (such as cystic fibrosis) or
pharmacologically or chemically induced (as occurs in the treatment of HIV/AIDS
or after organ transplant).

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 Clinical-epidemiological behavior of Diabetes Mellitus, in patients treated in
external consultation, at the Sagrada Familia Health Center in the La Floresta neighborhood, during 2018

There is considerable geographic variability in the incidence of type 1 and type 2 diabetes.
For example, Scandinavia has the highest rate of type 1 diabetes, with the frequency of this
being lowest in the Pacific basin (Japan and China, the annual incidence is 0.6 to 2.4 per
100,000); Europe and the United States share an intermediate frequency (8 to 20/100,000).
Much of the increased risk of type 1 DM is thought to reflect the frequency of high-risk
human leukocyte antigen (HLA) alleles in ethnic groups. from different geographical areas;
On the other hand, the prevalence of type 2 DM is higher in certain Pacific islands and the
Middle East and intermediate in countries such as India and the United States. This
variability is likely due to both genetic and environmental factors 8 .

6. METHODOLOGICAL DESIGN.

 TYPE OF STUDY.

The present study is descriptive.

 PLACE AND PERIOD OF EXECUTION.

It was held at the Sagrada Familia Health Center in the La Floresta neighborhood, District 4
of the City of Montero in the period from January 1 to November 31, 2018.

 POPULATION.

The population is made up of 82 patients with a diagnosis of Diabetes Mellitus belonging to

the La Floresta neighborhood. These data were provided by the health center staff, taken
from the family books where the clinical history of the patients is recorded.

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 Clinical-epidemiological behavior of Diabetes Mellitus, in patients treated in
external consultation, at the Sagrada Familia Health Center in the La Floresta neighborhood, during 2018

 SAMPLE.

Considering the accessibility of the Health Center and the high influx of patients there, as it
is a National reference center, the sample size will be calculated using the following
formula:

Z = 1.96

N = 82x(1.96) 2 x0.5x0.5

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 Clinical-epidemiological behavior of Diabetes Mellitus, in patients treated in
external consultation, at the Sagrada Familia Health Center in the La Floresta neighborhood, during 2018

(5%) 2 x(82-1)+(1.96) 2 x0.5x0.5

N = 82x(1.96) 2 x0.5x0.5 = 67.72 = 68

0.0025x(82-1)+(1.96) 2 x0.5x0.5

When executing the formula to obtain the study sample, a total of 68 clinical records of
patients diagnosed with Diabetes Mellitus were obtained.

Note. - It is good to emphasize that the necessary information could not be obtained from
the patients in the sample obtained due to bureaucratic and time issues at the health center.

Sagrada Familia, so in this work it will not be possible to obtain a conclusion and a final
recommendation that are related to the data obtained from the surveys and the statistical
results used in the methodology. However, an attempt has been made to mention the steps
to follow in said methodology, to use them in subsequent work.

 TYPE OF SAMPLING.

This is a non-probabilistic convenience sampling.

 PROCEDURE FOR SAMPLE COLLECTION.

 INCLUSION CRITERIA.

1. All patients with a diagnosis of Diabetes Mellitus treated at the Sagrada Familia Health
Center in the City of Montero, during the study period.
2. Patient with complete medical history and physical examination upon admission to the
Center.

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 Clinical-epidemiological behavior of Diabetes Mellitus, in patients treated in
external consultation, at the Sagrada Familia Health Center in the La Floresta neighborhood, during 2018

3. Patient who attended their appointments periodically (once a month) during the period
studied.

 EXCLUSION CRITERIA.

1. All patients with incomplete medical history and physical examination upon admission
to the hospital, from January 2018 to November 2018.
2. Patients who missed their appointments for 6 months or more during the study period.
3. Patients with a not well defined diagnosis.
4. Clinical records with illegible spelling.

• SOURCE OF INFORMATION.

The source of information was secondary, since it will be obtained directly from the records
of the patients selected in the sample.

• INFORMATION COLLECTION METHOD.

The collection method that will be used will be documentary review, because the
information will be obtained directly, extracting important data from clinical records using
the collection instrument that contains the variables to be studied for the research.

• COLLECTION INSTRUMENT.

The instrument that will be used will be a data collection form for patients with Diabetes
Mellitus, which consists of 5 sections with open and closed questions, in which the

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 Clinical-epidemiological behavior of Diabetes Mellitus, in patients treated in
external consultation, at the Sagrada Familia Health Center in the La Floresta neighborhood, during 2018

corresponding answer must be marked with an x according to the corresponding

information.

• DATA PROCESSING.

Based on the data that will be obtained from the sample to respond to the problem and
objectives set, a series of frequency and percentage tables will be presented for the
descriptive part of the research, which will facilitate the observation of trends in variables
such as: Sociodemographic characteristics, clinical manifestations and

complications, each one with its respective graphics and corresponding interpretations.
To collect the data, the instrument will be used: Data collection form for patients with
Diabetes Mellitus; The information will be tabulated and processed in the Word program
version 2007 of the Microsoft Windows 8 operating system. In relation to the nutritional
status variable, it will be evaluated using the WHO standard deviation or Z score tables,
which serve to standardize the degree of nutrition in children and adolescents up to 19 years
of age.

For the graphical representation of the tables, bar diagrams were made with the Excel 2007
program, Windows 8 version, where the frequency of each variable and its respective graph
were presented in relation to the most prominent variables. Circular diagrams were also
used to represent percentages and proportions in those cases where it is interesting, it will
not only show the number of times that a characteristic or attribute occurs in a tabular way,
but rather graphically, in such a way that the proportion in which that characteristic appears
with respect to the total can be better visualized. .

Finally, you will present it for the defense of the research in Power Point 2007, a program
designed to make presentations with outlined text, as well as slide presentations.

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 Clinical-epidemiological behavior of Diabetes Mellitus, in patients treated in
external consultation, at the Sagrada Familia Health Center in the La Floresta neighborhood, during 2018

 STUDY VARIABLES.

 STATEMENT OF VARIABLES BY OBJECTIVES

Goals Study variables

1. Establish the sociodemographic characteristics of Age, Sex, Place of residence and
the study population. Religion.
2. Know the personal pathological, non-pathological Pathological personal history.
and family history of patients with Personal Family History.
Mellitus diabetes Non-pathological personal history
3. Determine the nutritional status of patients seen Nutritional condition.
in the Hospital's outpatient clinic.
4. Mention the clinical characteristics in the study Clinical features.
sample.
5. Identify complications in the patients sampled in Complications.
this study

 TABULATION AND ANALYSIS PLAN.

In other dimensions of the work, in the analytical part in the crossing of variables, tables
will be presented in relation to the most important characteristics to highlight of the
research, which will respond to the proposed problem described previously, as well as to
the objectives set, for which which the following table has been proposed with the different
crossings of variables.

Variable Meaning
It will allow assessing the frequency of Diabetes
Age- Sex: Mellitus according to gender in relation to
predominant age groups.
Sex- Type of Diabetes Mellitus: It will allow establishing the frequency of the
type of Diabetes in relation to the sex that most

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 Clinical-epidemiological behavior of Diabetes Mellitus, in patients treated in
external consultation, at the Sagrada Familia Health Center in the La Floresta neighborhood, during 2018

Acute and chronic complications- Type of
Mellitus diabetes:
Nutritional Status - Type of Diabetes
Mellitus:
Clinical characteristics- Type of Diabetes:
Family Personal History - Type
of Diabetes:
predominates.
Identify both acute and chronic complications in
relation to the type of Diabetes Mellitus
diagnosed.
Determine the nutritional level of the s
patients in relation to the type of Diabetes
Mellitus that was diagnosed.
Point out the different clinical characteristics
that occur depending on the type of Diabetes.
Mention the relationship between the family
history of Diabetes Mellitus and the type of
Diabetes diagnosed in the sample.
selected.

7. CONCLUSIONS.

These conclusions will be announced once the data collection, tabulation and statistical
application and final analysis of the results are completed, according to the methodology
described above.

8. RECOMMENDATIONS.

The recommendations that will be given once the following work is completed, in relation
to the results and conclusions of the study, will be directed to the authorities of the La
Sagrada Familia Health Center in the La Floresta neighborhood of the City of Montero,
such as to the main decision makers at the national level.

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 Clinical-epidemiological behavior of Diabetes Mellitus, in patients treated in
external consultation, at the Sagrada Familia Health Center in the La Floresta neighborhood, during 2018

9. BIBLIOGRAPHY.

1. Macedo, S. F., Moura, M. F., Bandeira, N. P., Soares, A. C., Freire, R. W., Coelho, M.
M. (2,010). Risk Factors for Type 2 Diabetes Mellitus in Children. Latin American Scielo
Magazine, 18 (5):1-3. Retrieved from http://www.scielo.br/pdf/rlae/v18n5/es_14.

2. International Diabetes Federation (FID 2013). IDF Diabetes Atlas. (6). Retrieved from
https://www.idf.org/sites/default/files/SP_6E_Atlas_Full .

3. Baron, PF, and Márquez, E. (2,010). Type 2 Diabetes in children and adolescents .
Revista Medicina Interna de México, 26 (1), 36-47. Retrieved from
http://www.cmim.org/boletin/pdf2010/MedIntContenido01_09.

4. Latin American Diabetes Association (ALAD 2,008). Guides for diagnosis, control and
treatment of Type 2 Diabetes Mellitus with Evidence-Based Medicine. Pan American
Health Organization/ALAD. Retrieved from http://www.paho.org/spanish/ad/dpc/nc/dia-
guia-alad.

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 Clinical-epidemiological behavior of Diabetes Mellitus, in patients treated in
external consultation, at the Sagrada Familia Health Center in the La Floresta neighborhood, during 2018

5. American Diabetes Association (ADA 2012). Diagnosis and classification of Type 1

Diabetes Mellitus. Diabetes Care, 35(1). Retrieved
fromhttp://www.intramed.net/userfiles/2012/file/guias_diabetes1.

6. Camejo, M., García, A., Rodríguez, E., Carrizales, E., Chique, J. (2,012). Practical
Clinical Guide in Diabetes Mellitus. Epidemiological view of Diabetes Mellitus.
Venezuelan Journal of Endocrinology and Metabolism, 10 (1), 2-4. Retrieved from
http://www.svemonline.org/wp-content/uploads/2015/07/revista-svem-vol-10-2.

7. American Diabetes Association (ADA 2014). Clinical practice in the management of

Diabetes Mellitus. Diabetes Practice, 5 (2), 1-24. Retrieved from
http://www.bvs.hn/Honduras/UICFCM/Diabetes/ADA.2014.esp.

8. Longo, DL, Fauci, AS, Kaspe,r DL, Hauser, SL, Jameson, JL, Loscalzo, J. (2,012).
Harrison principles of internal medicine . 2(18). Mexico: McGraw-Hill.

9. Sosa Herlan, (2018) “Diabetes is not based in Montero”, El Norte newspaper article

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 Clinical-epidemiological behavior of Diabetes Mellitus, in patients treated in
external consultation, at the Sagrada Familia Health Center in the La Floresta neighborhood, during 2018

10. APPENDICES AND ANNEXES.

Data collection form for patients with Diabetes Mellitus.

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 Clinical-epidemiological behavior of Diabetes Mellitus, in patients treated in
external consultation, at the Sagrada Familia Health Center in the La Floresta neighborhood, during 2018

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 Clinical-epidemiological behavior of Diabetes Mellitus, in patients treated in
external consultation, at the Sagrada Familia Health Center in the La Floresta neighborhood, during 2018

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 Clinical-epidemiological behavior of Diabetes Mellitus, in patients treated in
external consultation, at the Sagrada Familia Health Center in the La Floresta neighborhood, during 2018

Form to summarize the data extracted from the family folders of patients with
diabetes mellitus.
PLANILLA CENTRALIZADORA DE INFORMACION

NUEMERO DE ANTECEDENTES ANTECEDENTES ANTECEDENTES

LUGAR DE ESTADO CARACTERISTICA
N.- MANZANO PERSONAS CON NOMBRES EDAD SEXO RELIGION PERSONALES PERSONALES NO PERSONALES COMPLICACIONES
RESIDENCIA NUTRICIONAL S CLINICAS
DIABETES PATOLOGICOS PATOLOGICOS FAMILIARES

39 3

40 4

41 5

43 4

44 4

45 5

46 5

48 6

49 4

50 4

52 2

53 6

54 2

55 5

56 5

58 4

TOTAL 68

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 Clinical-epidemiological behavior of Diabetes Mellitus, in patients treated in
external consultation, at the Sagrada Familia Health Center in the La Floresta neighborhood, during 2018

Photographs of the family folders of patients with diabetes mellitus within Salud la
Sagrada Familia.

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