Quality of Care for Patients with type 2 Diabetes in Lagos University Teaching Hospital

Abstract

Background/Objective: Results from clinical trials over the past decade have established a base for specific screening and prophylactic recommendations in patients with type 2 diabetes aimed at achieving optimal metabolic control and risk reduction for the development of chronic complications. We aimed to assess implementation of guidelines of diabetes care based on internationally accepted recommendations of the American Diabetes Association, in patients receiving treatment at the Diabetes clinic of the Lagos University Teaching Hospital. Methods: A cross sectional prospective study involving 114 patients from the Diabetes clinic of the Lagos University Teaching Hospital was carried out. Pre-tested questionnaires were administered. Aspects of plasma glucose, glycated haemoglobin testing, self monitoring of blood or urine glucose, and risk reduction using blood pressure measurements, foot examination, retinal examination, urine microalbumin screening, lipid assay, anti-platelet and ACE inhibitor therapy. The period the questionnaire referred to was the last 1 year of patient care. Results: A total of 63 males, 51 females were seen with type 2 diabetes with a mean age of 56.58+11.2 years. Mean duration of diabetes was 10.8±6.5years, mean BMI was 26.67+5.7kg/m2. Mean fasting plasma glucose was 162+20.4mg/dl. Only 14% of the patients had glycated haemoglobin measurement in the period under review with a mean HbA1c of 10.5+2.0%. All patients had regular blood pressure measurements during clinic visits, (average of 2-3 months) with mean blood pressure of 136.8+19.4/86.3+14.9 mmHg. 71% had foot examination during clinic visits, 48% had dilated fundoscopy, 92% had regular dipstix urinalysis during clinic visits, 50% practiced self monitoring of urine or blood glucose, 61% had regular lipid profiles, 49% were on anti-platelet aspirin therapy and 37.7% were on ACE inhibitors. Conclusion: Certain aspects of the recommendations of standards of medical care are below average. Indices of metabolic control show that the patients seen have poor glycaemic control and sub-optimal blood pressure control. Some aspects of care (glycated haemoglobin, self monitoring) possibly reflect adverse socioeconomic conditions while some possibly reflect inadequate information on the part of the attending residents or physicians. NQJHM Vol. 16 (1) 2005: pp. 6-9