Qualité des soins primaires Libre accès

Abstrait

Diabetes control in a university primary care setting in Thailand

Nataya Taweepolcharoen, Sutida Sumrithe, Narongchai Kunentrasai, Sumonthip Phraisuwanna

Objective To evaluate diabetes control status in a university primary care setting in Thailand using the American Diabetes Association (ADA) clinical guideline, and to determine factors associated with good glycaemic control.Methods Data were collected from 1510 medical records of patients with diabetes and compliant with reviews, attending the clinic regularly (at least three times) between January 2004 and June 2005.Results The percentage of patients who attained ADA goal for haemoglobin A1c (HbA1c) was 23.4%. The goals achieved by the highest and the lowest proportion of patients were measurement of triglycerides (49.6%) and low-density lipoprotein(LDL) (13.1%) respectively. Most patients (72%) received an annual eye examination and were evaluated for proteinuria. Approximately half the patients (50.5%) were not screened for microalbuminuria. Glycaemic control was significantly related to the duration of the disease measured by years since diagnosis. Males had significantly better control than females (adjusted odds ratio = 1.4, 95% confidence interval 1.1–1.8). Physician teaching or training status and group education were not associated with patients’ diabetic control.Conclusion A considerable proportion of patients with diabetes in the clinic could not achieve the ADA target goals. Quality improvement strategies, such as a computerised tracking and recall system, should be developed to improve this. Improvingglycaemic control especially in female patients with longer duration of disease, LDL management and microalbuminuria screening should be addressed as a priority in this primary care setting.