ASSESSMENT OF CARE FOR TYPE 2 DIABETIC PATIENTS AT THE PRIMARY CARE CLINICS OF A REFERRAL HOSPITAL

BACKGROUND: There is rapid increase in the incidence of Diabetes Mellitus (DM) in the Kingdom of Saudi Arabia (KSA), as in other countries. An optimal care of diabetic patients depends on the health care providers as well as the type of health care setting. Due to the severity of chronic complications in Type 2 diabetic patients, it is essential to assess both the practices of the providers and the patient outcomes at any clinical setting. OBJECTIVES: To assess the screening patterns of diabetes associated health care problems in primary care clinics of King Khalid University Hospital (KKUH) and while compare them to the current diabetes clinical practice recommendations of American Diabetes Association (ADA). METHODS: The retrospective review of charts of 103 eligible patients who attended the primary care clinics of KKUH over a 3 year-period (1/12001-31/12/2003) had provided 99 type 2 diabetic patients. The study variables included demographic data, complications, treatment, the provider screening practices (measurements of HbA1c, BP, Lipid profile, number of eye and foot examination). From these data, the frequency of provider screening tests, normalized by patient-year could be compared with the ADA guidelines. RESULTS: The mean age of 99 type 2 diabetic patients was 57 years, with a mean BMI of 30.8 kg/m2 and with a mean duration of diabetes of 11.8 years. Many had comorbidites or complications: 25% had retinopathy, 17.2% had nephropathy, and 12.1% had neuropathy. The HbA1c level of ≤ 7.0 was maintained by only 24.7% of patients. About 85% of patients had ≥ 1 lipid profile, during their follow-up period. During 2(nd) and 3(rd) year follow up only 30% had ≥ 1 HbA1c measurement and 26.5% (at 2(nd) year), 22%(at 3(rd) year) had ≥ 1 foot examination. The proportion of patients, who had ≥ 1 eye examination was also reduced during their follow up. The provider practice screening results per patient-year was well below the specified guidelines of ADA. CONCLUSION: Type 2 diabetic patients care at our primary care clinics did not adhere to the guidelines of ADA. The reasons for the deficiencies were not evident from this study. More detailed studies are needed to find out the relevant causes for the lack of adequate diabetic care at primary care clinics.