Abstract
BackgroundDue to the perennial shortage of diabetes specialists, primary care physicians (PCPs) constitute the largest diabetes care manpower in Nigeria. However, the competence of the PCPs to undertake this task is not known. This study was aimed at evaluating diabetes care knowledge and practice among PCPs in Southeastern part of Nigeria.MethodsThis was a cross-sectional study among PCPs in Southeastern Nigeria. Diabetes care knowledge and practices were evaluated using a structured self administered questionnaire.ResultsA total of 64 PCPs with mean duration of practice of 17.3 ± 11.6 years completed the study. 65.6% were in private practice and 50% attended to between 11 and 20 persons living with diabetes (PLWD) weekly. Majority (78.1%) had not participated in any diabetes training since graduation from medical school and 79.9% were not aware of any diabetes clinical practice guideline.The PCPs had adequate knowledge of classical symptoms of diabetes. However, they had very poor knowledge of glycemic thresholds for diagnosis of diabetes which was 26.6, 45.3 and 10.9% for fasting blood glucose (FBG), random blood glucose (RBG) and glycated hemoglobin (A1c) respectively.We observed serious gaps in diabetes care practice such that only 18.8% of the respondents performed foot examination on newly diagnosed PLWD while 28.1 and 39.1% provided counseling on foot care and hypoglycemia respectively. Annual comprehensive foot examination was conducted by only 12.5%, none of the physicians ever screened for microalbuminuria and only 21.9% conducted annual dilated eye examination. Majority (57.8%) rated their confidence in prescribing insulin as “low” and only 23.4% had ever prescribed outpatient insulin for type 2 diabetes in their practice. Glycemic monitoring was largely limited to FBG and only 17.2% monitored A1c. Duration of practice more than 10 years (OR 10.1; P 0.034) and non participation in diabetes training (OR 6.5; P 0.027) were significant predictors of poor diabetes care knowledge.ConclusionDiabetes care knowledge and practice were poor among PCPs in Southeast Nigeria. There is an urgent need to improve their capacity to provide diabetes care through periodic training.
Highlights
Due to the perennial shortage of diabetes specialists, primary care physicians (PCPs) constitute the largest diabetes care manpower in Nigeria
Majority of the respondents (65.6%) were in private practice and half of them attended to between 11 and 20 persons living with diabetes weekly
If our speculation is true, the public health impact of this observation is expected to be grave in Nigeria since the bulk of diabetes mellitus (DM) diagnosis and management rests on the shoulders of PCPs
Summary
Due to the perennial shortage of diabetes specialists, primary care physicians (PCPs) constitute the largest diabetes care manpower in Nigeria. A recent meta-analysis reported that approximately 5.8% (about 6 million) of adult Nigerians are living with DM [1] This figure has been likened to a tip of an iceberg as it is estimated that two-thirds of diabetes cases in Nigeria are yet undiagnosed [2]. To arrest the current situation and improve the quality of diabetes care in SSA, concerted efforts to institute optimal diabetes care are required These would entail the implementation of holistic strategies aimed at diabetes prevention through risk factor identification and lifestyle modification, as well as optimal glycemic control among subjects already living with diabetes. Landmark clinical trials have demonstrated that optimal glycemic control can prevent many of the diabetes related complications in both type 1 and type 2 diabetes [3, 4] Implementing these strategies requires among other factors, a knowledgeable and motivated diabetes care workforce
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