Diabetes control in a primary care setting: a retrospective study of 651 patients

BACKGROUND AND OBJECTIVES: As part of an ongoing evaluation of the process of care, the management of type 2 diabetes in primary healthcare settings was studied in a series of audits with the objective of improving diabetes care in a primary care center of the Saudi National Guard Health Affairs, Riyadh, Saudi Arabia. METHODS: A sample of 30 files was randomly selected every 2 weeks from a sampling frame of medical records of type 2 diabetes patients seen over the previous two weeks. The criterion of good management was arbitrarily defined as a glycated hemoglobin (HbA(1c)) less than 7%, with a test frequency of once every 3 months. The proportion of patients not conforming to the criterion was reported back to the care providers. Specially trained nurses did all randomization, data extraction, and entry. RESULTS: Data were extracted form 651 medical records, including 355 (54.5%) for females and 296 (45.5%) for males. Both the mean and median age of those studied was 53 years. Mean HbA(1c) was 9.0±2.0%, mean fasting plasma glucose was 9.9±3.9 mmol/L, and mean 2-hour postprandial plasma glucose was 15.0±5.3 mmol/L. In 20.6% (134/651) (95% CI, 17.5%–23.9%) of patients the HbA(1c) level was less than 7%. Only 10.4% (68/651) (95% CI, 8.2%–13.0%) had HbA(1c) measured in the previous 3 months that was less than 7.0% and thus met the criterion for good management. In the previous 3 months, 55.4% (95% CI, 51.5%–59.3%) had been tested for HbA(1c). CONCLUSIONS: Management of diabetes at the primary care level leaves much to be desired. There is a need for an ongoing process of evaluation to follow up the implementation of care guidelines.