Quality of medical care provided to type 2 diabetic patients attending Alexandria Main University Hospital, Egypt

Background
Diabetes mellitus is a major contributor to morbidity and mortality worldwide. A marked variability in the application of preventive and therapeutic strategies was documented. Good quality of care is associated with lower burden of complications.
Study objectives
The present study was conducted to assess the quality of medical care provided to type 2 diabetic patients attending the internal medicine outpatient clinic in Alexandria Main University Hospital.
Patients and methods
A cross-sectional survey was conducted on 490 type 2 diabetic patients. Patients were interviewed using a structured questionnaire containing data on personal and sociodemographic characteristics as well as their self-care practices. Records of interviewed patients for a set of performance measures for diabetes care during the last year were reviewed. Weight, height, and blood pressure were measured and a series of laboratory investigations were carried out in order to assess the outcome of diabetes care.
Results
The study included 490 diabetic patients, of whom 281 (57.3%) were male patients. Their mean age was 53.62 ± 10.72 years. The duration of diabetes among the studied patients ranged from 1 to 22 years, with a mean of 9.54 ± 4.78 years. Nearly one-third of them were not compliant with antidiabetic treatment; 44.1% were current smokers and 82% of them had never practiced physical exercise before. In the previous 3 months, glycosylated hemoglobin was ordered for only 60.8% of the studied patients. In the last year, foot and fundus examinations were carried out for nearly two-third of the studied patients (68.2 and 64.5%, respectively). Moreover, only 12.5, 26.1, and 38.5% of patients were investigated for microalbuminuria, serum creatinine, and blood lipids, respectively. Uncontrolled hyperglycemic state was diagnosed in a vast majority of cases (99.2%). Moreover, 78.6% were obese and 82% had hypertriglyceredemia.
Conclusion
Intermediate outcome measures – namely, poor glycemic control and high prevalence of obesity and hypercholesterolemia – denote suboptimal medical care and/or poor compliance of patients with self-care management practices. In order to improve quality of care of type 2 diabetes aiming at reducing the incidence of complications, improving outcome, and improving the quality of life of patients, multilevel intervention plan should be carried out.