Health care for diabetic patients in developing countries: a case from Egypt

The aim of this was to evaluate the pattern of care for diabetic patients in Alexandria as a model from a developing country. It is a cross-sectional multi-centric. One thousand diabetic patients who had diabetes for no less than one year were randomly selected from 14 out-patient clinics and diabetic centres. Results showed that monitoring of the glycaemic state was based, almost entirely upon fasting blood glucose levels, with only a small minority (4%) having HbA measurements. During the previous 12 months, an electrocardiogram had not been performed in 26% of the subjects studies and the fundus was not examined in 38%. Twenty nine percent did not receive neurological examination, and feet were not inspected in 24%. Testing for albuminuria, serum creatinine, blood cholesterol, and triglycerides was performed only in 34%, 37%, 36% and 32% respectively. Patient's habits in seeking care revealed that 78% regularly attended the medical centre for follow up, 64% followed dietetic instructions, and 89% were compliant with prescribed therapy. Only 8% did self examination of blood glucose and 26% checked glucose in urine by themselves. Generally, the pattern of care provided for health insured diabetic patients is better than that received by non-health-insured cases. It is concluded that in Egypt the quality of diabetes care differs in many aspects from the recommended standards and that structural as well as organisational improvements are urgently needed, particularly to guarantee adequate care to non-health insured patients.