Primary care physicians’ practice regarding diabetes mellitus diagnosis, evaluation and management in the West region of Cameroon

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Abstract

Background

Primary care physicians (PCPs) are the main providers of diabetes care especially in resource-limited countries which experience extreme shortage of specialists. The present study aimed to evaluate PCPs’ approach towards diabetes mellitus (DM) diagnosis, evaluation and management in Cameroon.

Methods

We carried-out a cross-sectional survey in February 2012 in the West Region of Cameroon. Using a structured pretested questionnaire, we interviewed all PCPs working in the region who were present at their working place when the investigators visited, and volunteered to be enrolled in the study.

Results

Sixty-six PCPs were interviewed. Their ages ranged from 24 to 56 years (mean 38.3, standard deviation 9.2 years). The levels of knowledge of PCPs regarding DM diagnosis were: 72.7%, 37.9%, 19.7% and 32.8% respectively obtained when using fasting plasma glucose, post-prandial glycemia, random glycemia and glycated hemoglobin as diagnostic tools. Only 6 PCPs (9.9%) prescribed the correct minimal work-up to evaluate diabetes patients at diagnosis. PCPs advised lifestyle modifications in 92.4% of cases, and thirty nine (53.1%) PCP’s used to prescribe both generic and specialty oral anti-diabetic drugs in case of uncomplicated type 2 DM management. The two main classes of anti-diabetic drugs prescribed were biguanides (77.3%) and sulfonamides (60.6%). Nearly all PCPs (97%) used to give frequent follow-up appointments to their patients. Ninety eight point five percent of participants were willing to receive any further continuous training on DM management.

Conclusion

PCPs knowledge and practices towards diabetes mellitus diagnosis, evaluation and management were not optimal, stressing the need to improve their capacities regarding diabetes care. As such, more educational initiatives should be taken on, alongside regular upgrade and dissemination of clinical guidelines.

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Most cited references 16

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Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women.

S N Blair, J Kampert, H W Kohl … (1996)

To quantify the relation of cardiorespiratory fitness to cardiovascular disease (CVD) mortality and to all-cause mortality within strata of other personal characteristics that predispose to early mortality. DESIGN--Observational cohort study. We calculated CVD and all-cause death rates for low (least fit 20%), moderate (next 40%), and high (most fit 40%) fitness categories by strata of smoking habit, cholesterol level, blood pressure, and health status. Preventive medicine clinic. Participants were 25341 men and 7080 women who completed preventive medical examinations, including a maximal exercise test. Cardiovascular disease and all-cause mortality. There were 601 deaths during 211996 man-years of follow-up, and 89 deaths during 52982 woman-years of follow-up. Independent predictors of mortality among men, with adjusted relative risks (RRs) and 95% confidence intervals (CIs), were low fitness (RR, 1.52;95% CI, 1.28-1.82), smoking (RR, 1.65; 95% CI, 1.39-1.97), abnormal electrocardiogram (RR, 1.64;95% CI, 1.34-2.01), chronic illness (RR, 1.63;95% CI, 1.37-1.95), increased cholesterol level (RR, 1.34; 95% CI, 1.13-1.59), and elevated systolic blood pressure (RR, 1.34; 95% CI, 1.13-1.59). The only statistically significant independent predictors of mortality in women were low fitness (RR, 2.10; 95% Cl, 1.36-3.21) and smoking (RR, 1.99; 95% Cl, 1.25-3.17). Inverse gradients were seen for mortality across fitness categories within strata of other mortality predictors for both sexes. Fit persons with any combination of smoking, elevated blood pressure, or elevated cholesterol level had lower adjusted death rates than low-fit persons with none of these characteristics. Low fitness is an important precursor of mortality. The protective effect of fitness held for smokers and nonsmokers, those with and without elevated cholesterol levels or elevated blood pressure, and unhealthy and healthy persons. Moderate fitness seems to protect against the influence of these other predictors on mortality. Physicians should encourage sedentary patients to become physically active and thereby reduce the risk of premature mortality.

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Management of type 2 diabetes in the primary care setting: a practice-based research network study.

S Spann (2006)

We wanted to describe how primary care clinicians care for patients with type 2 diabetes. We undertook a cross-sectional study of 95 primary care clinicians and 822 of their established patients with type 2 diabetes from 4 practice-based, primary care research networks in the United States. Clinicians were surveyed about their training and practice. Patients completed a self-administered questionnaire about their care, and medical records were reviewed for complications, treatment, and diabetes-control indicators. Participating clinicians (average age, 45.7 years) saw an average of 32.6 adult patients with diabetes per month. Patients (average age, 59.7 years) reported a mean duration of diabetes of 9.1 years, with 34.3% having had the disease more than 10 years. Nearly one half (47.5%) of the patients had at least 1 diabetes-related complication, and 60.8% reported a body mass index greater than 30. Mean glycosylated hemoglobin (HbA1c) level was 7.6% (SD 1.73), and 40.5% of patients had values <7%. Only 35.3% of patients had adequate blood pressure control (<130/85 mm Hg), and only 43.7% had low-density lipoprotein cholesterol (LDL-C) levels <100 mg/dL. Only 7.0% of patients met all 3 control targets. Multilevel models showed that patient ethnicity, practice type, involvement of midlevel clinicians, and treatment were associated with HbA1c level; patient age, education level, and practice type were associated with blood pressure control; and patient ethnicity was associated with LDL-C control. Only modest numbers of patients achieve established targets of diabetes control. Reengineering primary care practice may be necessary to substantially improve care.

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Personal exercise habits and counseling practices of primary care physicians: a national survey.

John Rogan, M Schäufele, Dan J. Stein … (1999)

Regular physical activity can reduce the incidence and prevalence of many chronic diseases. A vast majority of Americans cite their physician as their primary source of information regarding healthy lifestyle decisions. This study was designed to obtain information about the personal exercise behavior and counseling practices of primary care physicians, to evaluate the relationship between their personal and professional exercise practices, and to determine whether physician specialty is associated with these practices. A cross-sectional survey was mailed to a randomly selected sample of primary care physicians in the United States. A questionnaire was used to obtain detailed information on the personal exercise habits, counseling practices, and barriers to counseling of these physicians, regarding both aerobic exercise and strength training. 298 primary care physicians, comprising 84 family practitioners, 79 pediatricians, 58 geriatricians, and 77 internists. Frequency of physician exercise, exercise counseling, and relationship between these practices. Physicians who perform aerobic exercise regularly are more likely to counsel their patients on the benefits of these exercises, as are physicians who perform strength training. Pediatricians and geriatricians counsel fewer patients about aerobic exercise than family practitioners and internists. Counseling regarding strength training is less common in all physician groups surveyed, and lowest among pediatricians, of whom 50% did not advise these exercises for any of their patients. Inadequate time was noted by 61% and inadequate knowledge and/or experience by 16% of respondents as the major barriers to counseling regarding aerobic exercise. Physicians who exercise are more likely to counsel their patients to exercise. Inadequate time and knowledge/experience regarding exercise are the most common barriers to counseling identified. These findings suggest strategies that might increase physician exercise counseling behavior.

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Author and article information

Contributors

Ahmadou M Jingi: jingiahmadoumusa@yahoo.co.uk

Jobert Richie N Nansseu: jobertrichie_nansseu@yahoo.fr

Jean Jacques N Noubiap: noubiapjj@yahoo.fr

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): 4 April 2015

Publication date PMC-release: 4 April 2015

Publication date Collection: 2015

Volume: 15

Electronic Location Identifier: 18

Affiliations

[ ]Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon

[ ]Department of Public Health, Faculty of Medicine and Biomedical Sciences, Yaoundé, Cameroon

[ ]Internal Medicine Unit, Edéa Regional Hospital, Edéa, Cameroon

[ ]Medical Diagnostic Center, Yaoundé, Cameroon

Article

Publisher ID: 16

DOI: 10.1186/s12902-015-0016-3

PMC ID: 4403824

PubMed ID: 25881080

SO-VID: d431b64c-4e4e-4b64-a115-fb7a4fdeacd4

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. 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.

History

Date received : 3 December 2014

Date accepted : 30 March 2015

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ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: primary care physicians,diabetes mellitus,sub-saharan africa,cameroon

Data availability:

ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: primary care physicians, diabetes mellitus, sub-saharan africa, cameroon

Primary care physicians’ practice regarding diabetes mellitus diagnosis, evaluation and management in the West region of Cameroon

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Abstract

Background

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Conclusion

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Journal of the ASEAN Federation of Endocrine Societies

Most cited references 16

Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women.

Management of type 2 diabetes in the primary care setting: a practice-based research network study.

Personal exercise habits and counseling practices of primary care physicians: a national survey.

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