Diagnóstico e Classificação da Diabetes Mellitus

Objectives

The framework standardises the diagnosis, classification, recording and surveillance of diabetes mellitus across primary and hospital care, while using continuous monitoring to assess diagnostic capacity, morbidity-record quality and application of Directorate-General of Health standards for type 1 diabetes, type 2 diabetes and gestational diabetes.[1][2][3][4][5][6]

• Establish diabetes diagnostic criteria using venous plasma glucose and glycated haemoglobin (HbA1c), including fasting plasma glucose, random plasma glucose in symptomatic people, two-hour oral glucose tolerance testing and HbA1c thresholds.[1]
• Confirm an abnormal fasting glucose or HbA1c result in asymptomatic people through a second analysis after one to two weeks, and repeat the abnormal parameter where simultaneously measured diagnostic parameters are discordant.[1]
• Identify intermediate hyperglycaemia through impaired fasting glucose and impaired glucose tolerance, recognising these states as associated with increased risks of diabetes and cardiovascular disease.[1][2]
• Classify diabetes as type 1, type 2, gestational diabetes or another specific type, including diabetes associated with genetic defects, pancreatic disease, endocrine disorders, chemicals or medicines.[7][8]
• Recognise type 1 diabetes as autoimmune or idiopathic, and type 2 diabetes as commonly associated with obesity and other cardiometabolic conditions.[7][8]
• Identify gestational diabetes through fasting glucose in early pregnancy and, where indicated, a 75 gram oral glucose tolerance test between 24 and 28 weeks of gestation.[7]
• Update diagnostic and classification criteria in response to developments in genetics, immunology and epidemiology, and identify the stage of altered glucose metabolism to enable appropriate intervention and monitoring.[2]
• Use HbA1c for diagnosis in accordance with international recommendations while retaining other diagnostic parameters and avoiding exclusion of diabetes solely because HbA1c is below 6.5%.[9]
• Monitor the proportions of registered people with type 1 diabetes, type 2 diabetes and gestational diabetes, including the proportions in each group with a surveillance commitment.[2]
• Measure annual incidence of type 1 and type 2 diabetes among people registered with the relevant health unit.[2][5][6]

Implementation

Implementation operates continuously at local, regional and national levels through clinical documentation, information-system reporting and indicator-based oversight. Regional health administrations configure monitoring systems and provide supervision, while health-centre structures manage indicators and primary-care clinical councils support effectiveness and compliance.[7][2][10][3][4][11]

• Record confirmed diabetes and intermediate hyperglycaemia in the clinical record as a core requirement for care continuity, data quality and indicator eligibility.[7][3][4][11][12][13][14]
• Communicate hospital diagnoses through a clinical report to the person with diabetes and the relevant family or attending doctor, and issue the prescribed diabetes guide when a doctor confirms the diagnosis.[7]
• Assign regional health administrations responsibility for configuring information systems that monitor implementation and impact.[2]
• Assign clinical councils of health-centre groups responsibility for primary-care effectiveness and for issuing directions and instructions on compliance.[2]
• Use the Directorate-General of Health, through its Department of Quality in Health and National Programme for the Prevention and Control of Diabetes, to prepare and disseminate implementation-progress reports.[2]
• Manage indicators through groups of health centres, including ACES, with monitoring undertaken by ACES and regional health administrations and supervisory oversight provided by regional health administrations.[10][3][4][11][12][13]
• Use SI USF/UCSP information systems as the data source, applying eligibility definitions based on registration, recorded diagnosis and, for relevant measures, diabetes or maternal-health surveillance commitments.[10][3][4][11][12][13]
• Calculate registration and surveillance indicators as A divided by B multiplied by 100, expressed as a percentage of patients, with numerator and denominator populations defined for each diabetes group.[10][3][4][11][12][13]
• Calculate annual type 1 and type 2 diabetes incidence as A divided by B multiplied by 100 per year, where A is the number of registered people with a first recorded diagnosis and B is the registered population.[5][6]
• Monitor type 1 diabetes registration, type 2 diabetes and gestational diabetes diagnostic-recording measures six-monthly; monitor surveillance commitments for type 1 and type 2 diabetes quarterly; and monitor incidence annually.[10][3][4][11][12][13][5][6]
• Submit indicator reports by the 25th day of month n+1, use annexed indicator identity sheets as part of the evaluation framework, and define reference values after one year of applying the standard.[2][10][3][4][11][12][13][5][6]
• Apply no target to the documented type 1 registration and incidence indicators, while defining targets after one year for the type 1 surveillance-commitment, type 2 surveillance-commitment and gestational-diabetes surveillance indicators.[10][11][12][13][5][6]

Monitoring & Evaluation

The evaluation framework combines continuous implementation monitoring at local, regional and national levels with indicator-based measurement of diabetes diagnosis, registration, incidence and surveillance commitments.[2]Regional health administrations are responsible for configuring information systems to monitor implementation and impact, while health-centre groups and regional administrations undertake monitoring under regional supervisory oversight.[2][3][4][11]

• Monitor the proportions of registered people with type 1 diabetes, type 2 diabetes and gestational diabetes, including the proportions within each group who have an established surveillance commitment.[2]
• Measure the registration of people diagnosed with type 1 diabetes as a percentage of all registered people, calculated as A divided by B multiplied by 100.[10]This indicator assesses technical quality, effectiveness and record quality, and is monitored six-monthly.[10]
• Measure the proportion of registered people with type 2 diabetes who have a surveillance commitment using A divided by B multiplied by 100, expressed as a percentage of patients and monitored quarterly.[12]
• Measure the proportion of women with recorded gestational diabetes who have a surveillance commitment using A divided by B multiplied by 100, expressed as a percentage and monitored every six months.[13]
• Measure the type 1 diabetes surveillance-commitment indicator as a percentage of registered people with type 1 diabetes meeting the relevant surveillance criterion, with quarterly monitoring.[11]
• Measure annual incidence of type 1 and type 2 diabetes as A divided by B multiplied by 100 per year, where A is the number of registered people with a first recorded diagnosis and B is the total number of registered people.[5][6]
• Assess diagnostic capacity, morbidity-record quality and application of the Directorate-General of Health standard for type 2 diabetes and gestational diabetes.[3][4]
• Assess primary-care capacity to attract people with type 1 diabetes and support application of the relevant standard.[11]

Data are drawn from the information systems used by primary-care units and health-centre groups.[10]Eligibility for indicators is generally based on registration in the relevant health-centre group during the reporting period and a diabetes diagnosis recorded in the clinical record.[10]For gestational diabetes, eligibility includes women completing a pregnancy during the reporting period with a recorded gestational diabetes diagnosis.[4]The quality and completeness of clinical diagnosis recording are identified as critical factors across the diagnostic, registration and surveillance indicators.[3][4][11][12][13][14]

• Record confirmed diabetes and intermediate hyperglycaemia in the clinical record.[7]
• Communicate hospital diagnoses through a clinical report to the person with diabetes and the relevant family or attending doctor.[7]
• Use annexed indicator identity sheets as an integral part of the evaluation framework.[2]
• Submit indicator reports by the 25th day of month n+1.[10][3][4][11][12]
• Prepare and disseminate monitoring progress reports through the Directorate-General of Health, its Department of Quality in Health and the National Programme for the Prevention and Control of Diabetes.[2]
• Define reference values after one year of applying the guideline or standard.[10][3][4][11][12][13]
• Apply no target to the type 1 diabetes registration indicator and the annual incidence indicators.[10][5][6]
• Define targets after one year for the type 1 diabetes surveillance-commitment indicator and the type 2 and gestational diabetes surveillance indicators.[11][12][13]

Clinical accountability also includes confirmation of abnormal diabetes test results in asymptomatic people through a second analysis after one to two weeks, or repetition of the abnormal parameter where simultaneously measured results are discordant.[1]The source does not specify audit methods, sanctions, public reporting arrangements or outcome targets beyond the reporting, indicator and supervisory mechanisms described.[2][10]

Costing & Financing

No costs, budgets, financing sources, allocations, resource-mobilisation measures, funding gaps or economic assumptions are specified in the supplied extracts.[2][9][10][3][4][11][12][13][14][5][6]

Implementation requires information systems, clinical-record documentation, monitoring by health-centre groups and regional health administrations, and progress reporting by national health bodies, but the extracts provide no associated resource requirements or funding arrangements.[7][2]