Improving Diabetes Care: A Fijian Diabetes Service Improvement Study

BACKGROUND: Achieving good outcomes in type 2 diabetes mellitus patients' needs a decent integrated care service with access to resources. The Fiji Islands has one of the highest rates of diabetes disease burden and has available resources to alleviate the diabetic disease pandemic in its population, yet patient outcomes are getting worse. We hypothesize that a dysfunction in health-care delivery system may be accentuating the diabetic disease process; therefore, this service evaluation study was conducted to provide insight into the management of T2DM in a secondary care clinic setting. METHODS: We conducted a retrospective chart review of patient records for the past three years (2015-2018). Random quota sampling was used to extract patient folders over a one-month period. A total of 113 patient charts were analyzed which met the inclusion criteria. RESULTS: The overall glycemic levels were uncontrolled in every seven out of ten patients. Most of the patients were on combination drug therapy and at maximum dosing ranges. HbA1c tests, as a monitoring tool, were being inadequately used. Nonadherence to management was prominent in poor controlled patients, and physicians failed to provide appropriate interventions in this group. Nearly all the patients had not received eye assessments, foot risk assessment, and individualized dietetic counselling over three years. Macrovascular complications were more common than microvascular end organ damage. CONCLUSION: There is a high degree of uncontrolled glycemia and comorbidities in patients attending the service of study which is being perpetuated by poor integrated diabetes care. Strengthening educational initiatives, using validated strategic tools to streamline diabetic services and astute evidence-based resource allocation and management, is needed.