Standards of care in managing patients with type 2 diabetes in an outpatient clinic in tertiary care center in Sri Lanka

Background and objectives:T2DM is a fast-growing problem in Sri Lanka. Evaluating the service provided to these patients is important to improve the care plan. Therefore, we aimed to audit the standard of care given to these patients. Methods:A descriptive cross-sectional study among 3,000 patients with T2DM attending the diabetic clinic at National Hospital Sri Lanka from January to July 2016was performed. Results and conclusions:Monitoring of the blood pressure (BP), body mass index (BMI), HBA1c and lipid profile were performed in 95.8%, 96.5%, 59.6% and 42.3% respectively while none of the patients had waist circumference measured. Screening for retinopathy, diabetic foot was done in 89.3% and 99.9% respectively while screening for microalbumin is patients with normoalbuminuria was only in 31.2%. Mean HBA1c 8.3± 2.5 %, SBP 130±19.5 mmHg, BMI 26.6 ±4.6kg/m2, LDL 99.78 ±23.75 mg/dl, HDL 46.93 ±10.52 mg/dl and TG 127±42.34 mg/dl were comparable with metabolic parameters in other countries in the region. Only 24.3% of young diabetics without co morbidities, 29.3% of elderly diabetics with co morbidities and 22% of the rest of the diabetics achieved glycemic targets. Prescription rates of metformin, sulphonylureas, pioglitazone, DPP4 inhibitors and insulin were 90.8%, 58.8%, 0.6%, 11.9% and 26.9% respectively while none of the patients were on GLP-1 agonists or SGLT2 inhibitors. Among the patients with very poor glycemic control (HBA1c>10. 9%) 9.1% were on mono therapy and 71.3% were on dual therapy for glycemic control while only 56.7% were on insulin. Conclusion:Screening for metabolic parameters and complications were high while measuring HBA1c, lipid profiles and nephropathy needs to be improved. Measuring waist circumference and screening for psychosocial issues need to be incorporated in the care plan. The majority of patients were on state funded anti diabetic agents. Doctors should be made aware of better strategies in improving glycemic care among patients with poor glycemic control.