title: Quality of diabetes care in low- and middle-income Asian and Middle Eastern countries (1993-2012): 20-year systematic review.
abstract: OBJECTIVE
  To assess the extent to which people with diabetes in low- and middle-income countries (LMIC) of Asia and the Middle East met evidence-based care recommendations through a systematic review of published literature.
  
  
  METHODS
  Electronic searches of Medline and Embase were carried out for studies assessing quality of care among people with diabetes in Asia and the Middle East between 1993 and 2012. Benchmarking against American Diabetes Association guidelines, we reported level and proportions meeting recommended risk factor control (glycated hemoglobin [HbA1c], blood pressure, and low density lipoprotein-cholesterol [LDL]) and preventive care processes across different settings.
  
  
  RESULTS
  One hundred and fifteen publications met eligibility for inclusion (91 reported risk factor control, 7 reported preventive processes, and 17 reported both). Only China, Thailand, Malaysia and Philippines had nationally representative data. Mean HbA1c (6.5-11% or 48-97 mmol/mol), SBP (120-152 mm Hg), and LDL (2.4-3.8 mmol/l) varied greatly. Despite variation in availability of data, studies consistently showed that recommended care goals were not being achieved.
  
  
  CONCLUSIONS
  The practice of auditing and benchmarking against evidence-based guidelines appears to be uncommon in Asia and the Middle East and there was heterogeneity of reporting across studies, populations, and methods used. The available data showed inadequate care.
authors.affiliation: Centre for Chronic Disease Control, New Delhi, India; Public Health Foundation of India, New Delhi, India. Electronic address: roopa@ccdcindia.org.
authors.forename: Roopa
authors.initials: R
authors.lastname: Shivashankar
authors.affiliation: Brody School of Medicine at East Carolina University, Greenville, NC, USA.
authors.forename: Katy
authors.initials: K
authors.lastname: Kirk
authors.affiliation: Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Woon Cho
authors.initials: WC
authors.lastname: Kim
authors.affiliation: Center for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Chaturia
authors.initials: C
authors.lastname: Rouse
authors.affiliation: All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Tandon
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: K M Venkat
authors.initials: KM
authors.lastname: Narayan
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, GA, USA.
authors.forename: Mahammed K
authors.initials: MK
authors.lastname: Ali
mesh_terms: D000328:Adult; D000368:Aged; D001208:Asia / Q000453:epidemiology; D019985:Benchmarking / Q000592:standards*; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D008078:Cholesterol, LDL / Q000097:blood; D003906:Developing Countries; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D011203:Poverty; D011787:Quality of Health Care / Q000592:standards*; D012959:Socioeconomic Factors
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin
keywords: Asia; Developing countries; Diabetes mellitus; Middle East; Quality of care