Indicators of Quality of Clinical Care for Type 2 Diabetes Patients in Primary Health Care Centers in Qatar: A Retrospective Analysis

Abstract

Background Despite the high prevalence of type 2 diabetes mellitus in Gulf countries, standards of diabetes care at the primary care level have not been widely studied. Aim To compare the results of diabetes clinical indicators from the American Diabetes Association (ADA) 2017 guidelines to the reference benchmarks in the Behavioral Risk Factor Surveillance System. Materials and Methods A cross-sectional analysis of electronic medical records in 643 randomly selected adult patients with type 2 diabetes was undertaken. A checklist enabled the collection of sociodemographic, clinical, biochemical, and quality measurement data. Data were analyzed using Stata 9.0. The chi-squared test was used to compare two or more proportions. Results There were 643 patients (male = 60.3%; female = 39.7%), and the majority (71.7%) aged between 40 and 64 years. Common comorbidities were dyslipidemia (72.3%), hypertension (70%), obesity (50.1%), and preobesity (overweight) (37.9%). Over 15% were smokers. The most commonly prescribed diabetes medications were metformin (89.9%), dipeptidyl peptidase-4 inhibitors (61.1%), and sulfonylureas (49.3%). Only 35.5% (p < 0.0001) of patients met the reference glycated hemoglobin (HbA1c) cutoff level of 7.0%. The reference level for blood pressure control was met by 70.2% (p < 0.0001) and for low-density lipoprotein cholesterol, 73.8% (p < 0.0001). Albuminuria was present in 39.2%, and very low vitamin D level (<20 ng/ml) in 39.1%. Most patients had annual foot (89.6%, p < 0.0001) and eye (72.3%, p < 0.0001) examinations. Only 39.9% had referrals for dietary counseling, and there were lower rates of referrals and uptake for pneumococcal, influenza, and hepatitis B vaccines. Most (76.2%) did not have screening for depression. Conclusion The majority of the results met the ADA standards, while glycemic control, dietary counseling, and screening for depression were poor in comparison to the standards. Continuing education for clinicians, patient education for self-management, and targeted weight management are recommended.

Prevalence of Cardiovascular and Renal Co-morbidities in Patients with Type 2 Diabetes in the Gulf, a Cross-sectional Observational Study

“…Our study showed that metformin (81%) was the most commonly administered antihyperglycemic agent, followed by DPP4 inhibitors (46%). This is similar to the findings of a study conducted in Qatar, stating that the most commonly prescribed diabetes medication was metformin (89.9%), followed by DPP4 inhibitors (61.1%) and sulfonylureas (49.3%) [16]. In the present study, the choice and number of the anti-hyperglycemic agents/class did not differ across age and gender.…”

Formation of a system of target indicators for rating and integral evaluation of the efficiency of the organization of the provision of medical care to patients with diabetes mellitus in the Russian Federation regions

“…Примечательно, что в сравнении с данными других исследований по отбору показателей для оценки организации оказания медицинской помощи пациентам с СД, в нашем исследовании высокую оценку со стороны опрошенных экспертов получили показатели, характеризующие обеспеченность пациентов медицинскими изделиями и лекарственными препаратами. А в случае зарубежных исследований предпочтение отдается преимущественно клиническим диагностическим показателям, таким как доля пациентов, которым проведены один или несколько тестов на гликированный гемоглобин ежегодно; доля пациентов с положительными тестами на микроальбуминурию в течение года; доля пациентов, ежегодно выполняющих хотя бы один тест на ЛПНП и иные показатели [7,8].…”

“…Так, на национальном уровне эффективными индикаторами эффективности оказания медицинской помощи пациентам с СД являются как процессные показатели -доля пациентов, которым выполнено хотя бы одно исследования уровня гликированного гемоглобина за год, и доля пациентов, которым ежегодно выполняется хотя бы одно исследование на уровень липопротеинов низкой плотности (ЛПНП), так и результирующие показателидоля пациентов с самым последним уровнем холестерина ЛПНП менее 130 мг/дл и доля пациентов с последним уровнем артериального давления менее 140/90 мм рт.ст. [7,8].…”

Increased Levels of HbA1c in Individuals with Type 2 Diabetes and Depression: A Meta-Analysis of 34 Studies with 68,398 Participants

“…Depressive symptoms in individuals with T2DM are associated with poor glycemic control, impaired physical functioning, low quality of life, hospitalizations, diabetic complications, and high rates of mortality. However, depression is poorly recognized in T2DM and it is usually untreated [ 5 ].…”