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Improving glycaemic control in patients attending a Trinidad health centre: a three-year quality improvement project

AimTo determine the effect on glycaemic control over three years, by selecting patients living with diabetes or diabetes and hypertension from a crowded chronic disease clinic (CDC) in a public health centre and treating them in a special diabetic clinic (DiaC) using resources available at the health centre. MethodsAn uncontrolled observational cohort study. One hundred and one patients from the CDC volunteered to join the DiaC and were followed for three years in the DiaC. Patients in the DiaC were provided with greater consultation times, more frequent clinic appointments and more frequent lifestyle advice than patients in the CDC. HbA1c levels were done at the start of the project (0 months) and at three, 24 and 36 months after the start. The DiaC was run by a primary care physician (PCP) and registered nurse (RN). Results Eighty-six patients completed follow-up. The mean HbA1c +/– standard deviation scores at 0, 3, 24 and 36 months were: 9.44+/–1.27%, 9.50+/– 2.22%, 8.33+/–1.97% and 7.96+/–1.84% respectively (P0.0005 for difference between 0 and 36 months). ConclusionA special diabetic clinic run by a PCP and an RN in a primary care setting where regular monitoring of glycaemic control is done, where patients concerns and fears about diabetes are addressed, where patients are educated about diabetes, diet and exercise and advised on compliance with medication leads to improved glycaemic control after three years. This low-cost clinic could be readily established in other developing countries.


Terence Babwah

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