Journal of General Practice

Do we Achieve the Targets for Diabetic Patients; Deep Looks to Primary Care Practice

Abstract

Almoutaz Alkhier Ahmed and Abdulellah Qurashi

Introduction: Diabetes care to the standard targets is an art need trained health care provider’s work in harmony. It is not an easy job; it is a continuous process of hard team works. Primary care practice is a busy practice where diabetes care is part of a complex daily care covering other health problems. In spite of this multiple daily care services, we raised the question if our care took our patients to meet target goals settled by the American diabetes association or not?. Assessing the current situation is the first step to catch the standards. Objectives: To determine the degree of glycemic control by using HbA1c and lipid profile control by measuring total cholesterol, low density lipo-protein, high density lipo-protein and triglycerides. To detect variations in HbA1c, lipid or Vit D control during the year 2013 Methodology: Cross sectional study was designed and conducted at Alwaha medical specialist center; one of the National Guard health affairs / WR primary care centers. Chronic disease registry was designed. A list of 1224 diabetic patients' records were reviewed and 302 patients' records were randomly selected. HbA1c values were detected with total cholesterol (T-Chol), low density lipoprotein (LDL) and vitamin D. HbA1c and lipid profiles were clustered into three groups; group A (1st Jan – 30st April 2013), group B (1st May – 31st August 2013). Group C (1st Sep – 31st Dec 2013). The American Diabetes Association 2014 target goals for diabetic patients were adopted. Data was collected and analyzed using SPSS software. Results: Three hundred and two, medical records were reviewed (110 males, 192 females) with mean age 57.31 ± 11.47. The overall means of HbA1c 8.73 ± 2.04 , total cholesterol (T-Chol) 4.6 ± 1.17 mmol/L, low density lipoprotein (LDL) 2.7 ± 0.85 mmol/L, high density lipoprotein (HDL) 1.02 ± 0.23 mmol/L, Triglyceride (TG) 1.68 ± 1.08 mmol/L and vitamin D 42.32 ± 22.56 nmol/l were calculated as shown. There were no statistical differences in HbA1c between groups A vs B or C (7.65 ± 3.49 vs 8.03 ± 2.85 and 7.69 ± 3.28), P values were 0.3 and 0.9. For Vit D means there were no statistical differences between groups (32.46 ± 26.12 nmol/l vs 31.83 ± nmol/l and 29.54 ± 29.68 nmol/l; P values were 0.8 and 0.36. There was no statistically difference between male and female in their overall mean HbA1c values (HbA1c 8.49 ± 1.86 vs 8.86 ± 2.14); P value was 0.13. Males showed better LDL means than females; 2.54 ± 0.88 vs 2.81 ± 0.83 (P value 0.0082). Interestedly, those who did there HbA1c once, twice and thrice were 42.4%, 31.8% and 25.8% respectively while 61.2% meet ADA HbA1c target goal. Conclusion: Targeted glycemic and lipid control was difficult to achieve in primary care setting. More studies were recommended to analyzed barriers to achieve control and how to overcome them.