Discussion
retinopathy, T2DM, diabetes
RETINOPATHY, DENGUE FEVER, CHRONIC DISEASES, COMPLICATION, DIABETES
The majority of the participants were middle aged women, had low educational level and relied exclusively on public health coverage. The sociodemographic profile of our cohort was similar to other studies conducted in healthcare centers located in low resource settings in Latin America [Argentina has a high number of mobile cellular subscriptions per inhabitant (125.8 per 100 people) with a smartphone adoption in 2019 of 65% [Components of the DP were implemented in a pragmatic way, within the limitations generated by the local context and an overburdened provincial public health system. In this sense, during the implementation, many PCCs were forced to evacuate because of river floods. And after the floods, Corrientes was affected by a dengue fever epidemic affecting the implementation of the DP during the outbreak.Compliance to face to face training activities was higher than to remote learning activities among healthcare professionals. Barriers related with lack of time, infrastructure and technology skills (e.g. not having access to a personal computer or an email) as well as poor internet connectivity might be related with not engaging or withdrawals from on-line courses as reported in other studies [The results of the analysis of the quality indicators suggest that the synergy of multiple strategies to strengthen the primary care level promoted favorable changes in the management of T2DM and resulted in an improvement in process indicators.Process indicators related with access to lab tests and to ophthalmologists were very low at baseline but increased at 12 months and maintained at 24 months. The improvement of these indicators required reallocation of resources, and organizational changes within the healthcare centers. In our cohort, retinopathy was the most frequent microvascular complication at the baseline visit so although the proportion of participants who visited an ophthalmologist showed a statistically significant increase at 12 and 24 months compared to baseline, access to specialist care is still low.The DP was effective considering the simultaneous improvements in the process indicators related to laboratory exams (Hb1Ac, cholesterol, and creatinine) which may imply that the attending physicians had more information to plan the individual management of T2DM patients.Access to antidiabetic treatment, was high at baseline and increase at follow-up, with metformin being the most indicated drug 726/845 (85.9%), showing high adherence to the recommendations of the T2DM clinical practice guidelines. A 2009 Ministry of Health report on the use of chronic medication.T2DM showed a high variability in the prescription of antidiabetic medications and glibenclamide was the first line treatment in primary care [Although there was an increase in the proportion of persons with T2DM treated and undergoing HbA1c check-ups, it did not result on better metabolic control showing that other factors might affect the management of persons with T2DM [The inclusion of a diabetes registry system permitted the identification of aspects of diabetes care that were in need of improvement, highlighted the potential contribution of electronic health data to chronic care and increased awareness among health authorities regarding the limitations the health care system posed for persons with T2DM in terms of access to lab services and specialty care.In addition, algorithms developed for the clinical support system generated alerts mainly focused on improving key processes of care. In this sense, results showed an improvement in process indicators at 12 and 24 months but not on glycemic control. There is evidence that clinical decision support systems for healthcare professionals can improve adherence to CPG, screening, referrals, efficiency and decrease medical errors [Unlike other studies in developing countries which demonstrated that SMS messaging had a positive impact on HbA1c, our study showed a marginal effect on glycemic control at 24 months [Digital health interventions have become attractive to address the limitations of health systems in LMIC, mainly due to its accessibility, low cost, widespread use and applicability to a wide variety of health behaviors and conditions. Also, mobile phones are recognized as a viable platform to improve the provision of health services in low-income communities and for diabetes education. The integration of a digital health component in a public DP was innovative and well accepted among persons with T2DM who attend primary care clinics and hospitals [Digital Health has recently gained attention in the context of the COVID-19 pandemic, as it enabled the optimization of service delivery platforms and environments. Technology is playing an important role in redesigning management strategies for chronic diseases during pandemic and lockdown [