A brief evaluation of care at a diabetic clinic in a primary health care centre

Abstract

Introduction Type 2 diabetes is one of the commonest chronic conditions in Malta posing a major health burden as a result of the complications that may arise. Evaluating patient management and comparing them to standard guidelines such as those set by the International Diabetes Federation (IDF) is an important step in improving care. Objective The study aimed to assess whether the practice at the diabetic clinic in Mosta Health Centre is in line with IDF targets for glycosylated haemoglobin (HbA1c), lipid profile and urinary albumin/creatinine ratio (ACR). Method All patients who attended the diabetic clinic in November and December 2016 were included. For each, data was collected for investigations done retrospectively from the Information Clinical Manager system over the year preceding their appointment. Data collected included age, gender, HbA1c values, lipid profile readings and ACR values. Adherence to guidelines was calculated and significant trends were reported. Results The study involved 515 patients, of which 55.5% were males and 44.5% females. The majority were of the older age group (48.3% being older than 70 years). Results for each investigation considered are as follows: For HbA1c, 99.2% of patients had this test taken, with 89.1% having a second reading and 53.2% having a third reading over the year preceding the appointment. There was a statistical difference of HbA1c levels between males and females. Of all HbA1c values taken in this study 45.7% adhered to the IDF standards. For ACR, 55% of the total had a measurement. Of these, 69.6% were within normal limits. Of the 30.4% abnormal results, only 5.7% had the test repeated twice over 4 months. In this study 97.5% had at least a single lipid profile taken over the previous year. Of these, 88.4% had triglyceride levels <2.3 mmol/l, 28.3% had lowdensity lipoprotein (LDL) levels <2 mmol/l, and 86.7% had high-density lipoprotein (HDL) levels >1 mmol/l. Similar values were obtained for the 52.2% of patients who had two lipid profile readings and for the 17.3% of patients who had three readings over the year prior to appointment. Conclusion Most investigations were done as per IDF standards but there is still room for improvement. Adhering to guidelines is important and this may be improved by raising awareness of these guidelines among general practitioners. Development of local guidelines would be ideal.