Quality of care in type 2 diabetes in Iran; a cross-sectional study using patient-level data

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Abstract

Background

Appropriate service delivery, access to high quality of cares and optimal management of type 2 diabetes mellitus (T2DM) can decrease the risk of micro and macro vascular complications and mortality. Therefore, monitoring the quality of diabetes care, including keeping glycemic levels at an optimal level, is crucial. The aim of this study was to evaluate processes and outcome-related quality of care indicators, in T2DM using retrospective patient-level data from 2013 to 2017 in 15 Tertiary Diabetes Care Centers in Iran.

Method

A retrospective observational study was conducted among 1985 T2DM patients at public, semipublic and private diabetes centers. Annual tests for HbA1c, serum lipid (LDL), and screening for nephropathy were used to evaluate process-related indicators; and intermediate biomedical markers including HbA1c, blood pressure (BP), and LDL cholesterol, were used to assess outcome-related indicators.

Results

Data were extracted from 15 diabetes centers in five provinces in Iran. 62.7% of the patients were female, and the mean duration of diabetes in the patients was 14.7 years. Evaluation of process-related indicators showed that only 9% of patients took the HbA1c test. The percentage of the patients without annual low-density lipoprotein (LDL) test decreased from 13% in 2013 to 7% in 2017. The results of achieving to all indicators concurrently (ABC care) showed that less than 2% of the patients met the criteria of optimal process-related quality indicators.

The mean percentage of the patients with HbA1c under 7%, blood pressure (BP) less than 130/80 mmHg, and LDL less than 100 mg ^/dl in the selected provinces were 32.4, 55, and 71 respectively. However, the average of total achievement in ABC goals was 14.2%.

Conclusion

Our findings showed that the management of T2DM in all selected provinces was far from the optimal control in both processes and outcome-related indicators and therefore needs serious consideration and improvement.

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Most cited references 24

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IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030.

David Whiting, Leonor Guariguata, Clara Weil … (2011)

Diabetes is an increasingly important condition globally and robust estimates of its prevalence are required for allocating resources. Data sources from 1980 to April 2011 were sought and characterised. The Analytic Hierarchy Process (AHP) was used to select the most appropriate study or studies for each country, and estimates for countries without data were modelled. A logistic regression model was used to generate smoothed age-specific estimates which were applied to UN population estimates for 2011. A total of 565 data sources were reviewed, of which 170 sources from 110 countries were selected. In 2011 there are 366 million people with diabetes, and this is expected to rise to 552 million by 2030. Most people with diabetes live in low- and middle-income countries, and these countries will also see the greatest increase over the next 19 years. This paper builds on previous IDF estimates and shows that the global diabetes epidemic continues to grow. Recent studies show that previous estimates have been very conservative. The new IDF estimates use a simple and transparent approach and are consistent with recent estimates from the Global Burden of Disease study. IDF estimates will be updated annually. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

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Achievement of goals in U.S. diabetes care, 1999-2010.

Mohammed Ali, Kai McKeever Bullard, Jinan B Saaddine … (2013)

Tracking national progress in diabetes care may aid in the evaluation of past efforts and identify residual gaps in care. We analyzed data for adults with self-reported diabetes from the National Health and Nutrition Examination Survey and the Behavioral Risk Factor Surveillance System to examine risk-factor control, preventive practices, and risk scores for coronary heart disease over the 1999-2010 period. From 1999 through 2010, the weighted proportion of survey participants who met recommended goals for diabetes care increased, by 7.9 percentage points (95% confidence interval [CI], 0.8 to 15.0) for glycemic control (glycated hemoglobin level <7.0%), 9.4 percentage points (95% CI, 3.0 to 15.8) for individualized glycemic targets, 11.7 percentage points (95% CI, 5.7 to 17.7) for blood pressure (target, <130/80 mm Hg), and 20.8 percentage points (95% CI, 11.6 to 30.0) for lipid levels (target level of low-density lipoprotein [LDL] cholesterol, <100 mg per deciliter [2.6 mmol per liter]). Tobacco use did not change significantly, but the 10-year probability of coronary heart disease decreased by 2.8 to 3.7 percentage points. However, 33.4 to 48.7% of persons with diabetes still did not meet the targets for glycemic control, blood pressure, or LDL cholesterol level. Only 14.3% met the targets for all three of these measures and for tobacco use. Adherence to the recommendations for annual eye and dental examinations was unchanged, but annual lipid-level measurement and foot examination increased by 5.5 percentage points (95% CI, 1.6 to 9.4) and 6.8 percentage points (95% CI, 4.8 to 8.8), respectively. Annual vaccination for influenza and receipt of pneumococcal vaccination for participants 65 years of age or older rose by 4.5 percentage points (95% CI, 0.8 to 8.2) and 6.9 percentage points (95% CI, 3.4 to 10.4), respectively, and daily glucose monitoring increased by 12.7 percentage points (95% CI, 10.3 to 15.1). Although there were improvements in risk-factor control and adherence to preventive practices from 1999 to 2010, tobacco use remained high, and almost half of U.S. adults with diabetes did not meet the recommended goals for diabetes care.

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The quality of care. How can it be assessed?

A Donabedian (2015)

Before assessment can begin we must decide how quality is to be defined and that depends on whether one assesses only the performance of practitioners or also the contributions of patients and of the health care system; on how broadly health and responsibility for health are defined; on whether the maximally effective or optimally effective care is sought; and on whether individual or social preferences define the optimum. We also need detailed information about the causal linkages among the structural attributes of the settings in which care occurs, the processes of care, and the outcomes of care. Specifying the components or outcomes of care to be sampled, formulating the appropriate criteria and standards, and obtaining the necessary information are the steps that follow. Though we know much about assessing quality, much remains to be known.

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Author and article information

Contributors

Majid Davari: m-davari@tums.ac.ir

Yahya Bayazidi: ybayazidi@gmail.com

Abbas Kebriaeezadeh: kebriaee@sina.tums.ac.ir

Alireza Esteghamati: esteghamati@tums.ac.ir

Fatemeh Bandarian: fbandarian@tums.ac.ir

Zahra Kashi: kashi_zahra@yahoo.com

Adele Bahar: doctor_bahar2000@yahoo.com

Sepideh Yousefi: yousefi.sepideh73@gmail.com

Journal

Journal ID (nlm-ta): BMC Endocr Disord

Journal ID (iso-abbrev): BMC Endocr Disord

Title: BMC Endocrine Disorders

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6823

Publication date (Electronic): 17 May 2022

Publication date PMC-release: 17 May 2022

Publication date Collection: 2022

Volume: 22

Electronic Location Identifier: 133

Affiliations

[1 ]GRID grid.411705.6, ISNI 0000 0001 0166 0922, Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, , Tehran University of Medical Sciences, ; Tehran, Iran

[2 ]GRID grid.411705.6, ISNI 0000 0001 0166 0922, Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, , Tehran University of Medical Sciences, ; Tehran, Iran

[3 ]GRID grid.411705.6, ISNI 0000 0001 0166 0922, Endocrinology and Metabolism Research Center, , Tehran University of Medical Sciences, ; Tehran, Iran

[4 ]GRID grid.411623.3, ISNI 0000 0001 2227 0923, Diabetes Research Center, , Mazandaran University of Medical Sciences, ; Mazandaran, Iran

[5 ]GRID grid.472338.9, ISNI 0000 0004 0494 3030, Pharm-D, Faculty of Pharmacy and Pharmaceutical Science, , Islamic Azad University of Medical Sciences, ; Tehran, Iran

Article

Publisher ID: 1034

DOI: 10.1186/s12902-022-01034-2

PMC ID: 9112515

PubMed ID: 35578191

SO-VID: d04dd6bc-0f08-45fa-920d-49d50cbeb484

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 19 September 2021

Date accepted : 27 April 2022

Custom metadata

ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: quality of care,type 2 diabetes,optimal control,abc care,hba1c,iran

Data availability:

ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: quality of care, type 2 diabetes, optimal control, abc care, hba1c, iran

Quality of care in type 2 diabetes in Iran; a cross-sectional study using patient-level data

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Abstract

Background

Method

Results

Conclusion

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Journal of the ASEAN Federation of Endocrine Societies

Most cited references 24

IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030.

Achievement of goals in U.S. diabetes care, 1999-2010.

The quality of care. How can it be assessed?

Author and article information

Contributors

Journal

Affiliations

Article

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