Management of diabetes mellitus in three settings in Jamaica

ABSTRACT

OBJECTIVES: To evaluate the quality of diabetic care in three clinics (one of them private and the other two public) in Jamaica, which is a middle-income country with a high prevalence (13 percent) of diabetes. METHODS: During a six-week census in 1995 at the three clinics we collected data retrospectively on a total of 437 diabetic patients. One of the clinics was a specialist public-hospital clinic ("SPMC"), one was a private group general practice ("PRMC"), and one was a public polyclinic ("PUBMC"). The patients median age ranged from 56 years at SPMC, 9.2 years at PRMC, and 6.3 years at PUBMC. RESULTS: Fewer than 10 percent of the patients wer controlled with diet alone. Insulin was the most commonly prescribed agent at SPMC (46 percent), compared to 7 percent each at the two other clinics. Sulfonylurea drugs alone or in combination with metformin were the most common agents at PUBMC and PRMC. Overall, 40 percent of the patients had satisfactory blood glucose control of (<8 mmol/L fasting or <10 mmol/L postprandial). There was no significant difference among the clinics in the proportion of patients with satisfactory blood glucose control (P= 0.26). A blood glucose measurement had been recorded in the preceding year in 84 percent of the patients at SPMC, 79 percent at PRMC, and 67 percent at PUBMC. Glycosylated hemoglobin was infrequently measured 16 percent at SPMC, 10 percent at PRMC, and 0 percent at PUBMC. Overall, 96 percent of patients have had surveillance for hypertension, and 81 percent had had surveillance for proteinuria. Surveillance for foot and retinal complications was generally infrequent and had been noted in patients' clinical records most commonly at SPMC (14 percent for foot complications, and 13 percent for retinal complications). The staff at the three clinics seldom advised the diabetic patients on diet, exercise, and other nonpharmacological measures, according to the clinics' records. CONCLUSIONS: The management of diabetes in Jamaica fell short of international guidelines. Our results also indicate the need to better sensitize health care professionals to these standards in order to reduce the burden of diabetes. (AU)