Objective - To evaluate the standard of patient care at a diabetes clinic in a tertiary care hospital in Colombo, focussing on delivery of services to the patients and achievement of treatment targets.
Methods: Clinic records of 350 patients followed up at the diabetes clinic at Colombo South Teaching Hospital, Sri Lanka were studied for evaluation of patient care in key areas of diabetes management. The American Diabetes Association guidelines (ADA) 2012 management targets in diabetes were used as the standard (1). Key areas of diabetes management were then compared with National Diabetes Audit, 2009-2010, National Health Service (UK) and Australian National Diabetes Information Audit and Benchmarking 2009 (ANDIAB) of Australia
Results : Regular monitoring of blood pressure, blood glucose and lipids were carried out in 88%, 96% and 60% of patients while retinopathy, nephropathy screening and foot assessment were done in 74%, 75% and 19% respectively. The ADA standards were met in blood pressure control in 32% , blood glucose control in 35% and lipid control in 38%. Comparing UK and Australian audit data to this was limited due to non- uniformity of treatment targets (as this study used ADA guidelines but UK audit used NICE guidelines and ANDIAB , Australian guidelines).
Conclusion: Regular monitoring of blood glucose and blood pressure was undertaken in more than 85% of the patients. Annual lipid monitoring, screening for retinopathy and renal disease was done in a majority, while annual foot assessment, HbA1c and urine microalbumin assessments were done infrequently. Achieving treatment targets as defined by ADA need further improvement. Further education of healthcare workers on diabetes management and re-auditing the results next year will be beneficial in improving patient care. Also making HbA1c and urinary microalbumin assays available in the public sector will help in achieving glycaemic targets and detecting complications.