Review of Quality of Diabetes Care in Low- and Middle-income European Countries Open Access
Bahe, Beth Jennifer (2012)
Abstract
Abstract
Review of Quality of Diabetes Care in Low- and Middle-income
European
Countries
Objective and Data Sources: This
review of published literature (systematic
search of Pubmed and Embase databases) is to assess the current or
most
recent levels of quality of care for diabetes across European low-
and middle-
income countries (LMIC) to evaluate whether there are gaps in
execution of
known interventions and/or clinical guidelines. Study selection and Data
Extraction: Inclusion criteria explicitly described the
population (adult or children
diagnosed with type 1 or type 2 diabetes mellitus), and outcomes
(processes of
care, therapeutic outcomes, or occurrence of complications) of
interest. A
separate single reviewer extracted quantitative data from the
published articles
and the relevant data was synthesized, stratifying by study design
and type of
diabetes. Results: Out of an
article yield of 507 studies, twenty-seven studies
met inclusion criteria, including 24 adult population studies, and
3 focused on
children with type 1 diabetes studies. Across 8 population-based
adult studies,
the proportion of individuals' with A1c <8% ranged from
7.7-26.5%. Mean blood
pressure (BP) across the same studies ranged from 124-141 mmHg
(systolic)
and 76-85 mmHg (diastolic). Across 16 clinic-based studies,
individuals' mean
A1c ranged from 7.7-9.7%. Mean BP across the same studies ranged
from 131-173 mmHg
(systolic) and 77-97 mmHg (diastolic). Within 3 studies examining
outcomes for
children with type 1 diabetes mellitus, individuals' mean A1c
ranged from 8.5-
11.9%, and retinopathy prevalence ranged from 1.7-12%. A total of
8
studies achieved a total score of 3-4 indicating that the methods
were of fair
quality. Five studies had a total score of 5-6 demonstrating a good
assessment
of the study quality; all other studies had a score indicating a
poor study
quality. Conclusion: Quality of
care for diabetes is not optimal in European
LMICs, and al countries in the region were not represented in this
review.
Technological advances incorporated into the European low resource
settings
may enhance health systems and allow providers supplementary
resources for
patient care. This review emphasizes the need for increased
research to fill the
gaps in the execution of clinical guidelines, and proper monitoring
of diabetes
patients living in European LMICs.
Table of Contents
Table of Contents
Chapter 1 1
Introduction 1
Chapter 2 3
Significance of the Paper 3
Methods 3
Study Inclusion Criteria 4
Chapter 3 7
Results 7
Studies reporting survey outcomes 7
Studies reporting clinic-based outcomes 9
Studies reporting patient outcomes for children with type 1 diabetes 10
Main Findings 11
Themes emerging from studies 11
Chapter 4 13
Discussion 13
Outcomes 13
Implications 15
Consideration of Study Designs 19
Qualitative Implications 20
Limitations 21
Conclusion 22
Recommendations 23
Tables 28
Table 1 28
Table 2 34
Table 3 41
Appendix A 43
Exclusion Code Guidelines 43
Appendix B 44
Quality Score Assessment Guidelines 44
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