Improving Diabetes Care: A Fijian Diabetes Service Improvement Study

Area of Science:

• Endocrinology
• Public Health
• Health Services Research

Background:

• Fiji faces a high burden of type 2 diabetes mellitus (T2DM), despite available resources.
• Patient outcomes for T2DM in Fiji are deteriorating, suggesting systemic issues.
• A service evaluation was initiated to investigate T2DM management in secondary care.

Purpose of the Study:

• To evaluate the current management of type 2 diabetes mellitus (T2DM) in a secondary care clinic in Fiji.
• To identify factors contributing to poor patient outcomes in T2DM.
• To provide insights for improving integrated diabetes care services.

Main Methods:

• Retrospective review of 113 patient records from 2015-2018.
• Random quota sampling used for patient chart selection.
• Analysis focused on glycemic control, treatment, monitoring, and complication screening.

Main Results:

• Seven out of ten patients had uncontrolled glycemic levels.
• Inadequate use of HbA1c monitoring and physician-led interventions for nonadherence.
• Most patients missed essential screenings (eye, foot) and dietetic counseling; macrovascular complications were prevalent.

Conclusions:

• Significant uncontrolled hyperglycemia and comorbidities indicate deficiencies in integrated diabetes care.
• Strengthening patient education and utilizing strategic tools are crucial for streamlining services.
• Evidence-based resource allocation and management are necessary to improve T2DM care in Fiji.