Diabetes control in a primary care setting: a retrospective study of 651 patients

As part of an ongoing evaluation of the process of care, the management of type 2 diabetes in primary healthcare settings was studied in a series of audits with the objective of improving diabetes care in a primary care center of the Saudi National Guard Health Affairs, Riyadh, Saudi Arabia.

A sample of 30 files was randomly selected every 2 weeks from a sampling frame of medical records of type 2 diabetes patients seen over the previous two weeks. The criterion of good management was arbitrarily defined as a glycated hemoglobin (HbA(1c)) less than 7%, with a test frequency of once every 3 months. The proportion of patients not conforming to the criterion was reported back to the care providers. Specially trained nurses did all randomization, data extraction, and entry.

Data were extracted form 651 medical records, including 355 (54.5%) for females and 296 (45.5%) for males. Both the mean and median age of those studied was 53 years. Mean HbA(1c) was 9.0+/-2.0%, mean fasting plasma glucose was 9.9A+/-3.9 mmol/L, and mean 2-hour postprandial plasma glucose was 15.0+/-5.3 mmol/L. In 20.6% (134/651) (95% CI, 17.5%-23.9%) of patients the HbA(1c) level was less than 7%. Only 10.4% (68/651) (95% CI, 8.2%-13.0%) had HbA(1c) measured in the previous 3 months that was less than 7.0% and thus met the criterion for good management. In the previous 3 months, 55.4% (95% CI, 51.5%-59.3%) had been tested for HbA(1c).

Management of diabetes at the primary care level leaves much to be desired. There is a need for an ongoing process of evaluation to follow up the implementation of care guidelines.