An observational study for assessment of point-of-care management received by diabetic patients before referral to a tertiary care hospital

Abstract

Introduction: Quality of diabetes care is suboptimal worldwide and it varies in rural and urban areas. Indian studies assessing the quality of diabetic care are few. We conducted a study to identify the gap in diabetes management as rural patients received before referral to a tertiary care hospital. Methods: The study was conducted over 2 years in our institution. Rural patients managed previously outside our institution were included in the study. Patients were interviewed for treatment history. Prescriptions and related documents were evaluated for basic examinations, investigations, proper advices, and management processes. Results: A total of 352 diabetic patients were evaluated. Blood pressure (BP) checkup was more regular than blood sugar monitoring (91% vs. 58%). Glycosylated hemoglobin was monitored rarely (2%). Eye checkup (2%), screening of neuropathies (7%), autonomic features (3%), electrocardiography (11%), and lipid screening (9%) were infrequent. Urine microalbumin-creatinine ratio was checked rarely (1%). Advice on diet (62%), exercise (56%), smoking cessation (15%), and foot care (2%) were suboptimal. Usages of insulin, oral hypoglycemic agents (OHA), and antihypertensive agents were suboptimal. Only 86 cases (29%) out of 295 with indications of OHA got adequate dose of OHAs and only 5 cases (9%) out of 57 cases with indications of insulin got adequate dose of insulin. Among diabetic hypertensives (115 cases), only 19% got adequate dose of antihypertensives. Conclusion: Diabetic patients were managed inadequately. The study provides data for developing interventions for improving the quality of diabetes care of rural patients outside the tertiary care setup.

Keywords

• Blood pressure
• eye examination
• glycosylated hemoglobin
• insulin
• microalbumin-creatinine ratio
• neuropathy