To Observe Implementation of American Diabetes Association (ADA) Guidelines for Care of Type 2 Diabetics at Peripheral Diabetes Clinics (PDCs) in Pakistan

Abstract

OBJECTIVE — To observe the implementation of American Diabetes Association (ADA) guidelines for care of type 2 diabetics at Peripheral Diabetes Clinics (PDCs) in Karachi, Pakistan.

RESEARCH DESIGN AND METHODS — The study was performed using a retrospective medical chart review of 691 type 2 diabetic patients 20 years of age and older. All of these patients had a definitive diagnosis of type 2 diabetes and records were documented on their first visit. Four peripheral diabetes clinics in four townships of Karachi district which were in operation between 1 Jan 2005 to 29 Dec 2006 were selected.

RESULTS — A total of 691 patients (332 males and 359 females) with type 2 diabetes had a mean age of 50.94 ±10.4 years. Mean BMI was 26.6 ± 4.77 kg/m2 and 60% of these patients had a positive family history of diabetes. Comorbidities were largely present, 84.6% had hyperlipidemia, 59% were hypertensive, 31.3% had retinopathy, 22.6% had nephropathy and 18.6% had peripheral neuropathy.

On their first visit 86% had their blood pressure measured, 56% patients had serum creatinine measured, 45% had HbA1c measured, 31% patients had dilated eye examinations, and 25% had urine albumin screening. Of these patients, 44% had lower leg examination and 2% patients were suffering from diabetic foot ulcer.

Mean systolic blood pressure (SBP) was 138 ± 19.8 mm Hg, mean diastolic blood pressure (DBP) was 85.58 ± 9.6 mmHg. Mean fasting blood glucose levels was 194.32 ± 70.59 mg/dl, random blood glucose levels was 278.86 ± 100.75 mg/dl and mean HbA1c levels was 9.13 ± 1.6%. Mean cholesterol levels was 194.15 ± 42.79 mg/dl, mean triglyceride levels was 224 ± 118.12 mg/dl, HDL cholesterol levels was 39.16 ± 7.1 mg/dl and LDL cholesterol levels was 117.62 ± 31.16 mg/dl.

Management of type 2 diabetic patients was complex: 41% of patients on antiplatelet therapy; 27% on anti-hypertensive; 22% on insulin (includes Oral Hypoglycemic Agent + Insulin); 20.3% on angiotensin converting enzyme inhibitors and 15.6% on statin medications.

CONCLUSIONS —

Family physicians were not adequately following the ADA recommended guidelines for comprehensive management of diabetes patients. Inadequate documentation of medical records may reflect poor diabetes care and comorbid conditions of hypertension and hyperlipidemia were not optimally managed according to ADA guidelines. In short, a wide gap exists between practice recommendations and delivery of diabetes care by peripheral diabetes clinics.