Quality of diabetes care at the largest outpatient clinics in Vilnius

Abstract

Background.Essential data on the quality of diabetes care needed for the development of National Diabetes Programme in Lithuania are lacking. The aim of the study was to assess the quality of diabetes care compared to the local guidelines in Vilnius, Lithuania.Materials and methods.Retrospective data collection covering the period from 2012 to 2013 was performed in 5 Vilnius outpatient clinics assessing process and outcome indicators in type 1 (T1DM) and type 2 diabetes mellitus (T2DM) subjects.Results.In a sample of 1,719 patients (58.9% women, 92.6% T2DM) the annual HbA1c assessment rate was 88.6%. Glycaemic control was significantly better in T2DM compared to T1DM patients: average HbA1c was 7.0 ± 1.4% vs 9.1 ± 1.8% and HbA1c ≤ 7% in 59 vs 9.4%, respectively (p < 0.001); referrals to an endocrinologist were recommended in 56.3% of cases.Annual screening for diabetic foot, retinopathy, nephropathy, renal function and lipids was performed in 4.6, 24.4, 2.3, 29.3 and 13.2% of patients, respectively, with higher performance rate of retinal screening and urinary microalbumin in T1DM; BMI and blood pressure were recorded for 50.2 and 97.2% of patients, respectively.Prevalence of nephropathy, polyneuropathy, retinopathy, and angiopathy was 8.4, 36.2, 10.7 and 7.7%, respectively, with the higher prevalence in T1DM.Conclusions.The analysis revealed good glycaemic control in T2DM, but insufficient in T1DM. Continuous monitoring of diabetes complications and cardiovascular risk factors did not meet the local Diabetes Care Guidelines.

Guideline Adherence and the Factors Associated with Better Care for Type 2 Diabetes Mellitus Patients in Lithuanian PHC: Diabetes Mellitus Guideline Adherence in Lithuania PHC

“…Although some efforts to investigate the performance of diabetes care in Lithuania were observed [16], the present study is among the first ones aiming at assessment of the adherence to diabetes guidelines and at the identification of the predicting factors for greater adherence.…”

“…There is evidence showing that the achievement of specific goals for each of these indicators leads to better diabetes outcomes, and strong evidence demonstrates that major complications are reduced if these goals are achieved [15]. In Lithuania, a few studies were carried out indicating not optimal diabetes care in the country [16,17] however, the guideline adherence on diabetes care is not addressed in a systematic way [18].…”