Do current standards of primary care of diabetes meet with guideline recommendations in Trinidad, West Indies?
OBJECTIVE
Primary care management of diabetes was examined using the Caribbean Health Research Council (CHRC) guidelines.


METHODS
We retrospectively examined a cross-section of 646 type 2 people with diabetics over 12 months with 1st visit between 1997 and 2005.


RESULTS
There were more women (65.8%) than men (34.2%) with age range between 29 and 89 years. Blood pressure and weight were evaluated in >95% of patients at each centre. Waist circumference and BMI were not measured at any time and HbA(1)c was infrequently measured (1.6-7%) over the 12 months. Information on family history (87.5%), smoking and alcohol (78.1%), exercise (21.4%), socioeconomic status (19.4%) and education (0.3%), and fasting blood sugar (97.2%), lipid profile (51.8%) and serum creatinine (37.9%) were assessed at the 1st visit. At follow-up patients were advised on treatment compliance (47.2%), diet (34.2%), exercise (18.5%) and rarely on home monitoring of blood glucose (0.3%). Peripheral sensations, pedal pulses (6%), visual acuity (3.3%), fundoscopy (12.1%) and ECG (3.9%) were scarcely examined at the annual visit.


CONCLUSIONS
Current management of diabetes in primary care in Trinidad falls short of Caribbean guideline recommendations. The CHRC and Ministry of Health should jointly educate caregivers of diabetes to implement the guidelines, with annual audits to identify shortfalls in management.
Pinto Pereira
Lexley M
LM
Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago. lexleyp@gmail.com
Hinds
Avery
A
Ali
Issa
I
Gooding
Ravita
R
Ragbir
Michelle
M
Samaroo
Kavita
K
Nayak
Shivananda B
SB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D017028:Caregivers; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000523:psychology / Q000628:therapy*; D003927:Diet, Diabetic; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008019:Life Style; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*; D014300:Trinidad and Tobago
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents