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Disease Prevention and Control / Noncommunicable Diseases / Diabetes

Final Report: Institutional Response to Diabetes and Its Complications (IRDC)—
An Evaluation of the Quality of Diabetes Care

(DOTA Caribbean Diabetes Initiative)

IRDC

Full Text (30 pp, PDF, 1098 KB, with chapter links in Table of Contents)
IRDC Home Page |  IRDC Meetings:
2004 (Nassau, Bahamas) |  2003 (Miami, USA)
2002 (Ocho Rios, Jamaica)

Other Subregional Initiatives
- Central American Diabetes Initiative (CAMDI)
- Veracruz Initiative for Diabetes Awareness (VIDA)

Links: Diabetes Initiative for the Americas (DIA): Action Plan 2001–2006 |
PAHO Diabetes Page |  WHO Diabetes Page

Report Summary

Diabetes care and education are among the most important aspects in the fight against diabetes. Improvement in diabetes control is linked to better quality of life and survival. The present project was funded by the Declaration of the Americas on Diabetes (DOTA) and the Pan American Health Organization (PAHO). The aim of the study was to assess the quality of care for people with diabetes mellitus (DM) in four outpatient clinics in The Bahamas, one specialized clinic in Jamaica, and two hospitals in Saint Lucia. The study was an audit of medical records. Initially, the study was planned to be done only in outpatient clinics; but it was found that clinics in Saint Lucia do not keep patient records. Therefore, the audit was conducted in two hospitals in that country. Overall, 563 patient charts were reviewed (Jamaica, 297; Saint Lucia, 147; and The Bahamas, 119) by trained data-collectors.

Eye examinations were reported to have been performed in 19% of cases. with the largest figure being reported in the Bahamas and the lowest in Jamaica. Foot examinations were reported to have been performed only in 25.2% of charts and were more frequently reported in The Bahamas (58.0%) than in the other sites. The lowest proportion of charts with reported foot examination was Saint Lucia (2.9%). Overall 51.0% of cases were reported to have blood pressures of 140/90 mmHg or higher. The proportion was similar in the three sites. A fasting glucose of 8 mmol/L or higher was found in 66.7% of cases and was the most frequent in Saint Lucia (67.9%) and the lowest in The Bahamas (52.2%). Overall, 64.3% of patients were found to have poor glycemic control (HbA1c > 8.0% or FBG > 8 mmol/L). The proportion of patients with poor control varied from 38.0% in The Bahamas to 71.8% in Jamaica.

Many incomplete records were found in all seven sites. A very low proportion of records had information on important aspects of the medical history such as smoking or alcohol use, as well as explanations being given to patients. In most cases in The Bahamas, and in all of the cases in Saint Lucia, the height of patients was not recorded; and as a result of this, it was impossible to calculate the Body Mass Index (BMI).

As has been seen in previous reports, diabetes care in the three studied sites was found not to follow international standards. The proportion of persons with poor glycemic control reported here for the participating clinic in Jamaica and the two hospitals in Saint Lucia is comparable to previous studies in the Caribbean, but it was considerably lower in the centers in The Bahamas. The main predictors of good glycemic control were nutritional advice and non-pharmacological treatment such as diet, exercise, and weight reduction. In addition, patients in clinics in The Bahamas were shown to have achieved better glycemic control.

Given the high burden that diabetes presents to the Caribbean and the current trend in diabetes prevalence observed worldwide, there is an urgent need to act now and foster prevention strategies in order to achieve additional gains in years of life expectancy and quality of life.