Introduction: Diabetes mellitus (DM) challenges our health systems because of its prevalence, chronicity, complications, cost and complexity of care. Auditing care processes and outcomes is needed for monitoring implementation of existing guidelines, designing interventions and tracking progress. We assessed the care processes (CP) and intermediate outcomes (IO) among patients with DM who attended the diabetes clinic of a tertiary hospital in Nigeria between 2010 and 2015.
Patients/Methods: Each patients record was reviewed over a 24-month period. Data on selected care processes (clinic attendance, Diabetes Self-Management Education (DSME) session, clinical examination, and routine investigations) and outcomes (glycaemic control, blood pressure (BP) control, renal function and cholesterol levels) were extracted. Descriptive statistics were used to summarise the results and tests of association were done between selected variables.
Results: Among the 390 patients, 55.1% were middle-aged and 62.6% were females. Majority (92.3%) had type 2 DM while 76.4% had coexisting hypertension.
Forty-two percent of patients missed clinic appointments. Less than 5% had foot or eye examination done annually, while 32.8% and 16.4% respectively had the examinations done at least once in 24 months. All the patients had BP checks at least annually and 49% had a recent DSME session.
Urinalysis, lipid profile, estimated Glomerular Filtration Rate (eGFR) and glycated hemoglobin (HbA1c) were done at least once in 24 months in 36.4%, 48.0%, 48.9% and 49.7% of patients respectively.
Among the patients, 55% and 69% had good glycaemic control (HbA1c <7%) and BP control (<140/90 mmHg) respectively. The proportion of subjects that had optimal eGFR, urinalysis and LDL-cholesterol were 83%, 40% and 41% respectively.
Males and young adults were more likely to miss appointments, while patients with a recent DSME were likely to have more care processes. Patients who missed appointments had poorer glycaemic control.
Conclusion: The overall receipt of recommended care processes and attainment of optimal intermediate outcomes was inadequate. There is vast room for improvement.