Quality of diabetes care in Trinidad and Tobago: surveillance for risk factors and complications - abstract

ABSTRACT

Long-term complications of diabetes mellitus cause increasing disability and health care costs in many Caribbean countries. Clinical care of people with diabetes mellitus should detect and treat arterial hypertension and cigarette smoking which are risk factors for the development of long-term complications. Patients should also be screened for signs of complications of diabetes mellitus so that these may be treated at the earliest stage. This study aimed to evaluate the extent to which these objectives were achieved by health care services in Trinidad and Tobago. Data were abstracted from the case notes of 1723 patients with diabetes mellitus attending two hospital clinics, nine government health centres and eight general practitioners. Blood pressure (BP) was measured within the preceding 12 months for 94 percent of patients but 30 percent had BP o160/95 mm Hg despite anti-hypertensive drug use in 41 percent of all patients. Among diabetic patients treated for hypertension, only 40 percent had BP ó140/90 mm Hg. Smoking habits were recorded for 67 percent of hospital patients but only for 15 percent of primary care patients. For cases with available date, 17 percent were current smokers and 8 percent were ex-smokers. Examination of the feet was recorded for 14 percent of patients within the last twelve months and fundoscopy was recorded in only 4 percent. The BP was regularly measured and a high proportion of patients were treated for hypertension but BP control was unsatisfactory. Cigarette smoking was a significant and neglected problem. Screening for signs of diabetic complications was not performed systematically. Improved strategies for the preventive care of people with diabetes mellitus require implementation (AU)