Incorporating the results of diabetes research into clinical practice: celebrating 25 years of diabetes research and training center translation research

Quality Care of Patients with Diabetes Mellitus in the Diabetic Clinic at Al Wakra Healthcare Center, Qatar

Introduction: Diabetes mellitus is a chronic illness that requires continuous medical care. Patient health education and self-management aim to prevent acute complications and to reduce the risk of long-term complications. Care of diabetic patients is a complex process and requires many issues beyond glycemic control. This study is conducted to assess quality of care of diabetic patients in the diabetic clinic at Al Wakra Healthcare Center and to determine some factors that may affect the quality of this care.

Methodology: This is a descriptive, cross-sectional study. The target population was all diabetic patients (Type 2) that meet the inclusion criteria and registered at the center. Two checklists assessed the structure of diabetic care; the first checklist is for the essential items of care (thirteen items) and the second one is for the less essential items (ten items). The indicators of the process of diabetic care was assessed by a scoring system that depends on ten items for standard diabetic care by the primary care physicians in the past year. Assessment of the outcome was done according to an international quality assurance protocol and it includes: the degree of diabetic control, obesity, smoking among the diabetic patients and control of blood pressure. We added HbA1c to this list. Another questionnaire was designed to determine factors that may affect quality of diabetic care-related to patient's knowledge and attitude and it is divided into 4 sections: personal data, patient knowledge about diabetes, patient attitude toward care and clinical and biochemical assessments. A pilot study was carried out to test the questionnaires. Epi-info. Six statistical package was used for data entry and statistical analysis. Chi square or Fisher exact tests were used to test the significance, and P value <  0.05 was considered significant.

Results: The study showed that diabetic care at Primary Healthcare Centers (PHC) in Qatar represented by Al Wakra Primary Healthcare Center is better when compared to the care in other studies in different countries. 86.7% of physicians show that most of the structure items are good to fair except for the absence of chiropodist and identification cards for diabetic patients. Assessment of the process of care showed that there is good to fair recording in 91.75% of cases; foot examination is not recorded in most of cases; and fundus examination is not recorded in 31.7%. The outcome indicators showed that patient knowledge about diabetes is poor in 35% of cases, uncontrolled FBS in 75.6% of cases, uncontrolled HbA1 c in 57.8%; obesity in 63.5% and control of blood pressure is not achieved in 49% of cases.

Conclusion: Diabetic Clinic at Al Wakra Primary Healthcare Center provides good care for diabetic patients in terms of structure, process and outcome; however, more efforts are needed for refining these services.

Development and validation of The Personal Diabetes Questionnaire (PDQ): a measure of diabetes self-care behaviors, perceptions and barriers

AIM

To develop and evaluate the validity and reliability of The Personal Diabetes Questionnaire (PDQ), a brief, yet comprehensive measure of diabetes self-care behaviors, perceptions and barriers. To examine individual items to provide descriptive and normative information and provide data on scale reliability and associations between PDQ scales and concurrently assessed HBA(1c) and BMI.

METHOD

Items were written to address nutritional management, medication utilization, blood glucose monitoring, and physical activity. The initial instrument was reviewed by multidisciplinary diabetes care providers and items subsequently revised until the measure provided complete coverage of the diabetes care domains using as few items as possible. The scoring scheme was generated rationally. Subjects were 790 adults (205 with type 1 and 585 with type 2 diabetes) who completed the PDQ while waiting for clinic appointments.

RESULTS

Item completion rates were high, with few items skipped by participants. Subscales demonstrated good internal consistency (Cronbach α=.650-.834) and demonstrated significant associations with BMI (p ≤.001) and HbA(1c) (p ≤.001).

CONCLUSIONS

The PDQ is a useful measure of diabetes self-care behaviors and related perceptions and barriers that is reliable and valid and feasible to administer in a clinic setting. This measure may be used to obtain data for assessing diabetes self-management and barriers and to guide patient care.

Are persons with diabetes practicing healthier behaviors in the year 2001? Results from the Behavioral Risk Factor Surveillance System

BACKGROUND

To examine changes in modifiable health-risk behaviors of diabetic persons in the United States.

METHODS

A cross-sectional study was conducted of noninstitutionalized adults aged 18 years or older, in states that participated in the Behavioral Risk Factor Surveillance System in 1995 and 2001. Changes in self-reported health-risk behaviors among persons with diabetes are examined for those years (5,218 in 1995 and 13,733 in 2001 for the core instrument; 3,227 in 1995 and 9,304 in 2001 for the diabetes module).

RESULTS

From 1995 to 2001, the percentage of persons with diabetes who were obese, had ever been told their blood pressure or blood cholesterol was high, or had their blood cholesterol checked in the past year increased significantly. Significant increases were also reported among diabetic persons who were former smokers, received an annual influenza vaccination, ever received a pneumococcal vaccination, performed daily self-monitoring of blood glucose, received annual foot examination, and received annual dilated eye exam.

CONCLUSIONS

Continued emphasis needs to be placed on a multirisk factor approach to prevent, delay, and reduce the complications of diabetes.