Assessment of treatment goals attained by patients according to guidelines for diabetes management in primary care centres in North Trinidad.
BACKGROUND
the scientific literature is deficient in studies looking at the achievement of primary care diabetes treatment targets as stipulated by best practice guidelines in the Caribbean.


OBJECTIVE
assessment of treatment goals attained by patients according to the Caribbean Health Research Council (CHRC)/Pan-American Health Organization (PAHO) guidelines for diabetes management in primary care centres in North Trinidad. The primary interest of this study was the extent to which stated intermediate outcome measures were achieved. Secondarily, process measures and adherence to specific recommendations on pharmacotherapy were evaluated.


METHODS
this was a cross-sectional study where 225 patients with diabetes from five primary care centres were interviewed in October and November 2007. Data collected included age, sex, ethnicity, religious background, educational level and duration, diabetes type and duration since diagnosis, the presence of hypertension, current blood pressure, level of physical activity and current medications. Last documented serum cholesterol and HbA1c within the past year were obtained from patient records. Anthropometric measurements recorded were weight, height and waist and hip circumferences.


RESULTS
of patients with available values, 49.3% achieved the target total cholesterol of less than 200 mg/dL while 56.6% had an HbA1C level of less than 6.5%. Only 47.7% attained a blood pressure target of less than or equal to 130/80 mmHg. 25.2% had a Body Mass Index (BMI) of less than 25 kg/m(2). For waist circumference measurements, 40.8% of males and 2.1% of females were within recommended limits. Only 13.5% had 20 minutes or more of at least moderate exercise daily. No patient met all recommended target values for these six parameters.


CONCLUSIONS
there is poor achievement of treatment goals as set by best practice diabetes management guidelines. Results from this study may serve to inform primary care strategy revisions aimed at more widespread achievement of control targets which would ultimately abate the burden of illness in this population.
Department of Neurology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331, USA. jamorren@yahoo.com
John A
JA
Morren
Nelleen
N
Baboolal
Gershwin K
GK
Davis
Amanda
A
McRae
D000886:Anthropometry; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*; D012307:Risk Factors; D014300:Trinidad and Tobago / Q000453:epidemiology