Do current standards of primary care of diabetes meet with guideline recommendations in Trinidad, West Indies?

Pinto Pereira, Lexley M.; Hinds, Avery; Ali, Issa; Gooding, Ravita; Ragbir, Michelle; Samaroo, Kavita; Nayak, Shivananda B.

doi:10.1016/j.pcd.2009.03.003

« Previous Next »Primary Care Diabetes
Volume 3, Issue 2 , Pages 91-96, May 2009

Do current standards of primary care of diabetes meet with guideline recommendations in Trinidad, West Indies?

Lexley M. Pinto Pereira
- Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago
- Corresponding author at: The University of the West Indies, Faculty of Medical Sciences, EWMSC, Trinidad and Tobago. Tel.: +1 868 663 8613; fax: +1 868 663 8613.
Avery Hinds
- The North West Regional Health Authority, West Indies, Trinidad and Tobago
Issa Ali
- Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago
Ravita Gooding
- Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago
Michelle Ragbir
- Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago
Kavita Samaroo
- The North West Regional Health Authority, West Indies, Trinidad and Tobago
Shivananda B. Nayak
- Faculty of Medical Sciences, The University of the West Indies, St Augustine, Trinidad and Tobago

Received 4 December 2008; received in revised form 13 February 2009; accepted 22 March 2009. published online 27 April 2009.

Abstract

Aims

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 HbA₁c 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.

Keywords: Type 2 diabetes, Caribbean, Primary health care, Guidelines