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

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.


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

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