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Assessment of quality of care for the management of type 2 diabetes: a multicentre study from a developing country

Iqbal Syed Azam, Ali Khan Khuwaja, Ghazala Rafique, Franklin White

Background Complications of diabetes can be prevented or delayed by providing high quality care. This study aimed to document the quality of care provided to people with type 2 diabetes in Pakistan and to identify the difference in care offered at various clinics.Design Cross-sectional multi-centre study. MethodsInterviews were undertaken with 672 people with type 2 diabetes attending three different types of diabetes clinic (private clinic (A), nongovernmental organisation (B) and public clinic (C)) in Karachi, Pakistan. A structured questionnaire was used to collect socio-demographic and clinical information from patients; quality of care indicators were also confirmed by reference to patients’ medical records. ResultsOverall, 68% (A: 92%, B: 58% and C: 52%, P0.001) of study subjects were informed about diabetes complications. Blood pressure (BP) monitoring at every visit was completed for 80% of study respondents (A: 100%, B: 79% and C: 57%, P0.001). Foot examination was infrequent (53%, A: 98%, B: 52% and C: 8% (P0.001). Lipid profiles of 48% of patients had been done in the past 12 months (A: 77%, B: 16% and C: 50%, P0.001). Microalbumin testing had been performed in 32% of patients in the previous year (A: 77%, B: 09% and C: 05%; P0.001). Most participants had elevated glycaemic (58.2%) and BP levels (84.7%) with higher prevalence among people who attended clinics B and C (P0.001). Overall, 82.6% of study subjects had an elevated body mass index; this was almost equally prevalent across clinics. ConclusionMany patients with type 2 diabetes do not receive optimal diabetes care in Karachi. Among the different settings, care provided in private health sector clinics was of a better standard. However, our results reveal a need for overall improvement in the quality of diabetes care. Further research is also needed to evaluate the reasons for poor diabetes care, and to identify the most cost-effective means to address these.