Quality of care of diabetes in jamaica 1995
Download
1 / 44

Quality of Care of Diabetes in Jamaica (1995) - PowerPoint PPT Presentation


Quality of Care of Diabetes in Jamaica (1995). Rainford Wilks Epidemiology Research Unit Tropical Medicine Research Institute University of the West Indies. (DOTA/UDOP, Ocho Rios, Jamaica, March 2002). Epidemic of Type 2 Diabetes (2). Indo-Trinidadian (35-69 years)

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha

Download Presentation

Quality of Care of Diabetes in Jamaica (1995)

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Quality of Care of Diabetes in Jamaica(1995)

Rainford Wilks

Epidemiology Research Unit

Tropical Medicine Research Institute

University of the West Indies

(DOTA/UDOP,

Ocho Rios, Jamaica, March 2002)


Epidemic of Type 2 Diabetes (2)

Indo-Trinidadian(35-69 years)

Prevalence MenWomen

  • 1961-62 11.6%18.9%

  • 197719.5%21.6%

    Afro-Trinidadian(35-69 years)

    Prevalence MenWomen

  • 1961-62 2.5%5.4%

  • 19778.2%14.8%

Poon King et al. 1968; Beckles et al.,1986


Epidemic of Type 2 Diabetes (3)

Prevalence in Jamaica

1960 (>15 years) 1.3%

1970 (25-64 years) 8.1%

1995 (>15 years)17.9%

1999 (25-74 years)13.4%

Tulloch 1961; Florey et al 1972; Ragoobirsingh et al 1995; Wilks et al 1999


Diagnosis of Diabetes:Three Methods

1.Random plasma glucose > 11.1 mmol/L on 2 separate occasions + symptoms (polyuria, polydipsia, unexplained weight loss)

2.FPG > 7.0 mmol/L on 2 separate occasions

3.2-hour plasma glucose > 11.1 mmol/L during OGTT on 2 separate occasions

Adapted from The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 1997;20:1183-1197.

World Health Organisation 1999. Report of a WHO Consultation: Definitions, diagnosis and classification of diabetes mellitus and it complications


FPG

2-Hour PG on OGTT

Diabetes Mellitus

Diabetes Mellitus

126 mg/dL

7.0 mmol/L

200 mg/dL

11.1

mmol/L

Impaired Fasting

Impaired Glucose

Glucose

Tolerance

110 mg/dL

6.1 mmol/L

140 mg/dL

7.8

mmol/L

Normal

Normal

Glucose Tolerance Categories

Adapted from The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 1997;20:1183-1197.

1-2


Components of Cardiovascular Risk

Major Risk Factors

  • Smoking

  • Dyslipidaemia

  • Diabetes Mellitus

  • Age >60 years

  • Gender (Men and Postmenopausal women)

  • Family history of cardiovascular disease :

    • Women <65 y or men <55 years


Components of Cardiovascular Risk Stratification in Patients with Hypertension (TOD)

  • Heart Diseases

    • Left Ventricular hypertrophy

    • Angina or prior myocardial infarction

    • Prior coronary revascularisation

    • Heart failure

  • Stroke or transient ischaemic attack

  • Nephropathy

  • Peripheral arterial disease

  • Retinopathy


Blood Pressure Categories JNC VI


Risk Stratification and Treatment


Type 2 DiabetesManagement Goals

  • Eliminate symptoms and improve well-being

  • Prevent and retard microvascular complications

    • optimize glycemic control

    • target blood pressure levels

  • Reduce macrovascular events

    • optimize glycemic control

    • target blood pressure levels

    • target lipid levels


Type 2 DiabetesMetabolic Targets

ParameterTarget Value

Fasting glucosewhole blood4.4-6.7 mmol/Lplasma-referenced5.0-7.2 mmol/L

HbA1coptimal<6%goal<7%action level>8%

Total cholesterol<5.2 mmol/L

LDL-Coptimal<2.6 mmol/Linitiate treatment>3.35 mmol/L

HDL-C>1.15 mmol/L

Triglycerides< 2.30 mmol/L

Blood Pressure< 130/80

ADA Clinical Practice Recommendations 2001

Diabetes Care 2001 Supplement, Jan. 2001

DaADAa from American Diabetes Association. Diabetes Care. 2001; 24 (suppl 1): S33-S43; The National Cholesterol Education Program (NCEP) Expert Panel. JAMA. 1993; 209: 2015-3023.

4-2


Treatment Algorithm

Nonpharmacologic therapy

Very symptomatic

Severe hyperglycemia

Ketosis

Latent autoimmune diabetes

Pregnancy

Monotherapy

Sulfonylureas/Benzoic acid analogue

Biguanide

Alpha-glucosidase inhibitors

Thiazolidinediones

Insulin

Combination therapy

Insulin


BackgroundHypertension

  • Adequate control of HTN reduces morbidity and mortality

  • HTN can be asymptomatic

    • surveillance is critical to detection

  • HTN often co-exists with other risk factors for cardiovascular disease eg obesity, smoking, sedentary lifestyle, dyslipidaemia


Aims of Quality-of-Care Studies

  • To evaluate the level of surveillance for Hypertension and Diabetes.

  • To evaluate the quality of care for Hypertension and Diabetes in 3 different settings.


Methods (QC Survey)

  • Case recruitment

    • Diabetes

      • sequential clinic attenders over 6 weeks

      • Aim to recruit 200 subjects per centre

      • Diabetes - Doctor diagnosed, on treatment with insulin or oral hypoglycaemics

    • Hypertension

      • surveillance of clinic attenders 30 yrs and over


Data Collection

  • Retrospective data from medical records

  • Data used from index visit excluded

  • Data

    • Medical history

    • Records of weight, height, blood pressure, blood glucose, urea, creatinine and urinalysis

    • Medication

    • Evidence of surveillance for TOD

    • Provision of advice on non-pharmacological approach


Characteristics of Study Population by Clinic Type (Diabetes)


Prevalence of Treatments Types by Clinic Type


Monitoring and Control of Blood Glucose, by Clinic Type, Jamaica, 1995

**

***

***

PUBMC=government polyclinic; PRMC=group private general practice; SPMC=specialist public-hospital diabetic clinic

**p<0.01; ***p<0.001


Surveillance of Lifestyle and Other Risk Factors by Clinic Type


Monitoring and Control of Hypertension (1) by Clinic Type (Jamaica, 1995)

*

***

***

*p<0.05; ***p<0.001


Good Blood Pressure Among Diabetics with Hypertension on Treatment


Monitoring and Control of Hypertension (2) by Clinic Type (Jamaica, 1995)

***

**

**

***

***

***

*

*p<0.05; **p<0.01 ***p<0.001


Surveillance of Complications of Diabetes by Clinic Type (Jamaica, 1995)

***

***

***p<0.001


Surveillance of Complications of Diabetes and Management of Lifestyle Factors by Clinic Type(Jamaica, 1995)

***

***

***

***p<0.001


Management of Lifestyle Factors by Clinic Type (Jamaica, 1995)

***

***p<0.001


Quality-of-Care Summary

  • Satisfactory blood glucose control was achieved in 40-50% of patients

  • Surveillance for Target Organ Damage was infrequent

  • Quality of care fell below accepted levels


Monitoring and Control of Blood Glucose by Clinic Type (Diabetes)


Surveillance of Complications of Diabetes by Clinic


Management of Lifestyle Risk Factors by Clinic (Diabetes)


Collaborators

Kingston, Jamaica

-Terrence Forrester

--Franklin Bennett

-Norma McFarlane-Anderson

-Marvin Reid

-Lincoln Sargeant


Hypertension, Diabetes & Lipid Status in Jamaica: Prevalence & Incidence Surveys & Quality of Care

Rainford Wilks

Epidemiology Research Unit

Tropical Medicine Research Institute, UWI


Quality of Care ofHypertension & Diabetes in Jamaica


Baseline Characteristics by Clinic Type (Hypertension)


Monitoring and Control of Hypertension by Clinic Type (Hypertension)


Monitoring and Control of Hypertension by Clinic Type (Hypertension)


Drug Treatment of Hypertension by Clinic Type (Hypertension)


Surveillance of Lifestyle Risk Factors by Clinic (Hypertension)


Management of Lifestyle Risk Factors by Clinic (Hypertension)


Summary

  • Prevalence Estimates of Hypertension, Diabetes, Obesity and Hyperlipidaemia have been derived.

  • Risk factors like obesity, excessive salt intake and sedentarism are all amenable to individual and population intervention.


Summary

  • Collaboration between all the related sectors, aimed at generating appropriate protocols is urgently required.

  • Despite the need for further studies, there is sufficient data on which to guide policy, especially if these data are integrated with other sources, for example the Survey of Living Conditions.


Summary

  • Further studies are required

    • to determine effectiveness of intervention strategies aimed at reducing the risk factors so far identified.


Quality of Care Summary

  • Satisfactory BP control was achieved in less than 20% of patients

  • Satisfactory blood glucose control was achieved in 40-50% of patients

  • Surveillance for Target Organ Damage was infrequent

  • Quality of care fell below accepted levels


ad
  • Login