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SQU MED J, APRIL 2009, VOL. 9, ISS. 1, PP.

32-36, EPUB 16TH MAR 2009 SUBMITTED - 28TH JULY 08 REVISION REQ. 21ST AUG 08, REVISION RECD. 26TH AUG 08 ACCEPTED - 28TH AUG 08

CLINICAL AND BASIC RESEARCH

Quality of Diabetes Care: A cross-sectional observational study in Oman
*Ahmed Al-Mandhari,1 Ibrahim Al-Zakwani,2 Omayma El-Shafie,3 Mohammed Al-Shafaee,4 Nicholas Woodhouse5

‫ﺟﻮﺩﺓ ﺍﻟﺮﻋﺎﻳﺔ ﻟﺪﺍﺀ ﺍﻟﺴﻜﺮ : ﺩﺭﺍﺳﺔ ﻣﻘﻄﻌﻴﺔ ﻭﺻﻔﻴﺔ ﻓﻲ ﻋﻤﺎﻥ‬
‫ﺃﺣﻤﺪ ﺍﳌﻨﺪﺭﻱ، ﺍﺑﺮﺍﻫﻴﻢ ﺍﻟﺰﻛﻮﺍﻧﻲ، ﺃﻣﻴﻤﻪ ﺍﻟﺸﻔﻴﻊ، ﻣﺤﻤﺪ ﺍﻟﺸﺎﻓﻌﻲ، ﻧﻴﻜﻮﻻﺱ ﻭﻭﺩﻫﺎﻭﺱ‬
‫ﺍﳋﻼﺻــﺔ: ﺍﻟﻬــﺪﻑ: ﺗﻘﻴﻴﻢ ﺟﻮﺩﺓ ﺍﻟﺮﻋﺎﻳﺔ ﺍﻟﺼﺤﻴﺔ ﺍﳌﻘﺪﻣﺔ ﳌﺮﺿﻰ ﺩﺍﺀ ﺍﻟﺴــﻜﺮ ﻓﻲ ﻋﻤﺎﻥ. ﺍﻟﻄﺮﻳﻘﺔ: ﻫﺬﻩ ﺩﺭﺍﺳــﺔ ﻣﻘﻄﻌﻴﺔ ﰎ ﻓﻴﻬﺎ ﺍﺧﺘﻴﺎﺭ ﻧﺼﻒ ﻋﺪﺩ‬ ‫ﺍﳌﺮﺿــﻰ ﺍﻟﺬﻳﻦ ﺭﺍﺟﻌﻮﺍ ﺳــﺘﺔ ﻣﺮﺍﻛﺰ ﻟﻠﺮﻋﺎﻳﺔ ﺍﻟﺼﺤﻴﺔ ﺍﻷﻭﻟﻴﺔ ﺧﻼﻝ ﺷــﻬﺮ ﻳﻮﻧﻴــﻮ ﻣﻦ ﻋﺎﻡ 5002 ﺑﺼﻮﺭﺓ ﻣﻨﻬﺠﻴﺔ . ﺍﺳــﺘﺨﺪﻡ ﺍﻹﺣﺼﺎﺀ ﺍﻟﻮﺻﻔﻲ ﻟﺘﺒﻴﺎﻥ‬ ‫ﺍﳌﻌﻄﻴﺎﺕ. ﺍﻟﻨﺘﺎﺋﺞ: ﺑﻠﻎ ﻋﺪﺩ ﺍﳌﺮﺿﻰ ﺍﳌﺼﺎﺑﲔ ﺑﺪﺍﺀ ﺍﻟﺴﻜﺮ ﺍﻟﺬﻳﻦ ﺷﻤﻠﺘﻬﻢ ﻫﺬﻩ ﺍﻟﺪﺭﺍﺳﺔ 034 ﻣﺮﻳﻀﺎ )ﻣﻨﻬﻢ 362 ﺍﻣﺮﺃﺓ %16-( . ﻛﺎﻥ ﻣﺘﻮﺳﻂ ﻋﻤﺮ‬ 169) 39% ‫ﺍﻟﻌﻴﻨﺔ 21 ± 25 ﺳﻨﺔ ﺑﻴﻨﻤﺎ ﻛﺎﻥ ﺍﳌﺪﻯ ﺑﲔ 6 ﺇﻟﻰ 48 ﺳﻨﺔ . ﻓﻘﻂ ﻓﻲ %04 )171 ﻣﺮﻳﻀﺎ( ﰎ ﺍﻟﻔﺤﺺ ﺍﻟﻌﺸﻮﺍﺋﻲ ﻟﺴﻜﺮ ﺍﻟﺪﻡ ، ﻣﻘﺎﺑﻞ‬ ‫ﻣﺮﻳﻀﺎ( ﰎ ﻓﺤﺺ ﺳﻜﺮ ﺍﻟﺪﻡ ﻋﻨﺪﻫﻢ ﻋﻠﻰ ﺍﻟﺮﻳﻖ .ﻭﻫﺬﺍ ﻳﻌﻨﻲ ﺃﻥ %97 )933 ﻣﺮﻳﻀﺎ( ﺣﺼﻠﻮﺍ ﻋﻠﻰ ﻓﺤﺺ ﺍﻟﺴﻜﺮ ﻓﻲ ﺍﻟﺪﻡ ﺳﻮﺍﺀ ﻛﺎﻥ ﺫﻟﻚ ﻋﺸﻮﺍﺋﻴﺎ ﺃﻭ‬ ‫ﻋﻠﻰ ﺍﻟﺮﻳﻖ . ﺃﻣﺎ ﺍﻟﻔﺤﻮﺹ ﺍﻷﺧﺮﻯ ﻓﻜﺎﻧﺖ ﻛﻤﺎ ﻳﻠﻲ: %47 )713 ﻣﺮﻳﻀﺎ ( ﰎ ﻓﺤﺺ ﺍﻟﻬﻴﻤﻮﻏﻠﻮﺑﲔ ﺍﻟﺴﻜﺮﻱ ﻭﺍﻟﺒﺮﻭﺗﲔ ﺍﻟﺸﺤﻤﻲ ﺧﻔﻴﺾ ﺍﻟﻜﹶ ﺜﺎﻓﺔ ﺑﻴﻨﻤﺎ‬ ‫ﹸ ﱠ ﹾ ﹺ ﱡ ﹶ‬ ‫ﹸ‬ :‫ﰎ ﻗﻴﺎﺱ ﺿﻐﻂ ﺍﻟﺪﻡ ﺍﻻﻧﻘﺒﺎﺿﻲ ﻭﺍﻻﻧﺒﺴــﺎﻃﻲ ﻓﻲ %59 ﻣﻨﻬﻢ )904 ﻣﺮﻳﻀﺎ( . ﻛﺎﻧﺖ ﺍﻟﻔﺤﻮﺹ ﻛﺎﻣﻠﺔ ﻓﻲ %85 ﻣﻦ ﺍﻟﻌﻴﻨﺔ )942 ﻣﺮﻳﻀﺎ( ﻭﺷــﻤﻠﺖ‬ ‫ﻓﺤﺺ ﺍﻟﻬﻴﻤﻮﻏﻠﻮﺑﲔ ﺍﻟﺴــﻜﺮﻱ ﻭﻗﻴﺎﺱ ﺿﻐﻂ ﺍﻟﺪﻡ ﻭﺍﻟﻜﻮﻟﻴﺴــﺘﻴﺮﻭﻝ ﺍﻟﻜﻠﻲ ﻭﺍﻟﺒﺮﻭﺗﲔ ﺍﻟﺸــﺤﻤﻲ ﺧﻔﻴﺾ ﺍﻟﻜﹶ ﺜﺎﻓﺔ ﻭ ﺍﻟﺒﺮﻭﺗﲔ ﺍﻟﺸﺤﻤﻲ ﻣﺮﹾﺗﹶﻔﻊ ﺍﻟﻜﹶ ﺜﺎﻓﹶﺔ‬ ‫ﹸ ﱠ ﹾ ﹺ ﱡ ﹶ‬ ‫ﹸ‬ ‫ﹸ ﱠ ﹾ ﹺ ﱡ ﹸ ﹺ ﹸ‬ (7%>) ‫ﻭﺍﻟﺪﻫــﻮﻥ ﺍﻟﺜﻼﺛﻴــﺔ . ﻛﺎﻥ ﻟﺪﻯ ﻓﻘﻂ %4.2 )6 ﻣﻦ ﻣﺠﻤــﻮﻉ 942 ﻣﺮﻳﻀﺎ( ﻧﺘﺎﺋﺞ ﺿﻤﻦ ﺍﳊﺪﻭﺩ ﺍﻟﻄﺒﻴﻌﻴﺔ ﻣﻦ ﻣﻘﻴﺎﺱ ﺍﻟﻬﻴﻤﻮﻏﻠﻮﺑﲔ ﺍﻟﺴــﻜﺮﻱ‬ ‫ﻭﺿﻐــﻂ ﺍﻟﺪﻡ )<=031/08( ﻭ ﺍﻟﻜﻮﻟﻴﺴــﺘﺮﻭﻝ )<2.5ﱈ/ﻝ( ﻭ ﺍﻟﺒﺮﻭﺗﲔ ﺍﻟﺸــﺤﻤﻲ ﺧﻔﻴــﺾ ﺍﻟﻜﹶ ﺜﺎﻓﺔ )<5.3ﱈ/ﻝ( ﻭ ﺍﻟﺒﺮﻭﺗﲔ ﺍﻟﺸــﺤﻤﻲ ﻣﺮﹾﺗﹶﻔﻊ ﺍﻟﻜﹶ ﺜﺎﻓﹶﺔ‬ ‫ﹸ ﱠ ﹾ ﹺ ﱡ ﹶ‬ ‫ﹸ‬ ‫ﹸ ﱠ ﹾ ﹺ ﱡ ﹸ ﹺ ﹸ‬ ‫)>-1.1<86.1ﱈ/ﻝ( ﻭ ﺍﻟﺪﻫﻮﻥ ﺍﻟﺜﻼﺛﻴﺔ )<8.1ﱈ/ﻝ(. ﺍﳋﻼﺻﺔ: ﻛﺎﻥ ﻫﻨﺎﻙ ﺗﺪﻭﻳﻨﺎ ﺟﻴﺪﺍ ﻟﻘﻴﻢ ﺍﳌﺆﺷﺮﺍﺕ ﺍﳌﺴﺘﺨﺪﻣﺔ ﻟﺘﻘﻴﻴﻢ ﺍﳉﻮﺩﺓ. ﻋﻠﻰ ﺍﻟﺮﻏﻢ ﻣﻦ ﺫﻟﻚ‬ .‫ﺗﻌﺘﺒﺮ ﻧﺴﺒﺔ %4.2 ﻣﻦ ﺍﳌﺮﺿﻰ ﺍﻟﺬﻳﻦ ﻳﻘﻌﻮﻥ ﻓﻲ ﺍﳊﺪﻭﺩ ﺍﻟﻄﺒﻴﻌﻴﺔ ﺍﳌﻌﺮﻭﻓﺔ ﻋﺎﳌﻴﺎ ﻣﻨﺨﻔﻀﺔ ﺟﺪﺍ‬ . ‫ﻣﻔﺘﺎﺡ ﺍﻟﻜﻠﻤﺎﺕ: ﺍﳉﻮﺩﺓ ، ﺩﺍﺀ ﺍﻟﺴﻜﺮ ، ﺍﳌﺆﺷﺮﺍﺕ ، ﻋﻤﺎﻥ‬

ABSTRACT Objectives: The objective of this study was to evaluate the quality of diabetes care in Oman. Methods: This was a crosssectional observational study. Fifty percent of all those attending six general health centres in June 2005 were systematically selected for the study. Descriptive statistics were used to describe the data. Results: A total of 430 diabetic subjects were included. Just over 6% percent of the subjects were female (n = 263). The overall mean age of the cohort was 52 ± 2 years ranging from 6 to 84 years. Only 40% (n = 7) and 39% (n = 69) of the diabetics had their random blood sugar (RBS) and fasting blood sugar (FBS) documented, respectively. However, 79% (n = 339) had either RBS or FBS done according to the records. Documentation for the other measurements ranged from 74% (n = 37) for HbAc and LDL (low density lipoproteins)-cholesterol to 95% (n = 409) for systolic and diastolic blood pressure (SBP/DBP) readings. A total of 58% (n = 249) of patients had non-missing values of HbAc, SBP/DBP, total cholesterol, LDL-cholesterol, HDL (high density lipoproteins)-cholesterol, and triglycerides. Only 2.4% (6 out of 249 diabetics) were simultaneously within goal for HbAc (<7%), SBP/DBP (<=30/80mmHg), total cholesterol (<5.2mmol/L), LDL-cholesterol (<3.3mmol/L), HDL-cholesterol (>. - <.68mmol/L), and triglycerides (<.8mmol/L). Conclusion: There was good documentation of values for the indicators used in the assessment of quality. However, the proportion (2.4%) of those meeting internationally recognised goals for the three diabetes-related factors was extremely low. Key Words: Quality; Diabetes; Indicators; Oman.

1 Department of Family Medicine & Public Health, Sultan Qaboos University Hospital, Muscat, Oman; 2Department of Pharmacy, Sultan Qaboos University Hospital, Muscat, Oman; 3Department of Medicine, Sultan Qaboos University Hospital; 4Department of Family Medicine & Public Health, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman; 5Department of Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman;

*To whom correspondence should be addressed. Email: manar96@yahoo.com

families and health care systems. assessing the quality of care provided by these centres is essential for improving such care. links with specialty expertise. primary health care centres play a major role in the management of chronic illnesses. this would help in reducing the cost of managing such complications and improve the quality of life of diabetic patients. Furthermore.4% in the Yemen to 19. six centres were specifically selected for the study based on their distance from the University Hospital.Q UALIT Y OF DI ABETE S CAR E: A C ROSS-SE C TIONAL OBSERVATIONAL ST UDY IN OM AN Advances in Knowledge • This is the first study to highlight the quality of diabetes care in a regions where diabetes is becoming an important factor in regional health problems. high density lipoproteins-cholesterol (HDL). the projected prevalence is estimated to be 308 million. General practitioners should be aggressive in controlling risk factors associated with diabetes • • • • The nurse’s role in diabetes care should be enhanced. The Chronic Care Model (CCM) provides a blueprint for changing office systems to improve chronic patient care. triglycerides. These centres were representative of the Muscat region in terms of population covered and type of services provided. IABETES MELLITUS IS A MAJOR HEALTH problem that is associated with significant morbidity and mortality. to increase sharply in the next 25 years.2 Diabetes also imposes a huge cost burden on the patients.1 These problems are also reflected in the Middle East where the prevalence of obesity is also increasing along with that of diabetes mellitus 2 (DM2). with 1 of them dying every 10 seconds.5% in the UAE in patients between 20-79 years of age. Ultimately. which in 2007 varied between 3. This produced data on 50% of the total number of patients from each centre. The following are recommended: Self-management support to patients.3 The target population was 860 patients who visited the six centres during the month of June 2005. In 2007. the 2007 figure was 14% and is expected. more vigilance is required to improve the care of diabetes in Oman. The number of affected individuals is increasing rapidly from 94 million in 2003 to 246 million in 2007 representing 6. it is essential to assure delivery of high D quality care. Monitoring compliance at the point of care with active follow-up to ensure the best outcome.1 These startling figures are due mainly to a massive increase in the worldwide prevalence of obesity. and supported by provider education. The aim of this study was to assess the quality of diabetic care in the primary health care centres in Oman. 75% of adults will be overweight and 41% obese by 2025 if its citizens continue to gain weight at the current rate. In 2025. In Oman. Applications to Patient Care Given the background of a less than desirable quality of care in Oman. A checklist of indicators was developed based on the Omani Ministry of Health guidelines for the management of diabetes mellitus in primary health care centers. systolic and diastolic blood 33 . total cholesterol. Interventions should focus on patient education.1 Given the high prevalence rates of diabetes and the direct link between its poor control and significant morbidities such as blindness. METHODS Out of 26 primary health care centres in Muscat. as in other countries. the cost of diabetes mellitus (DM) in the USA alone was estimated to be 232 billion USD. Evidence-based guidelines should be integrated into care. The estimated number of diabetics world wide is greater than 240 million. low density lipoproteins-cholesterol (LDL). training of primary care physicians and other patient care providers in behavioural change and redesign of local systems of delivering care. myocardial infarction and renal failure. and reminder systems.4 The variables assessed included recorded HbA1c. Maintenance of disease registries. In the USA.0% of the adult population. Therefore. Every second patient attending the clinics was selected for the study.

< = 130/< = 80 SBP/DBP. years Random Blood Sugar (RBS).136 0. n (%) Fasting Blood Sugar (FBS).56 ± 0. < = 125. 4.2mmol/L).0%).1 40 (24%) 339 (79%) 8.2. n (%) Patients at goal.01 85 (71%) 44 (37%) 21 (17%) 1.3mmol/L). n (%) Patients at goal. n (%) Presence of either RBS or FBS value.5 33 (44%) 8. Total cholesterol. mmHg Mean±SD Patients at goal.8 ± 2. <5.68. HDL-cholesterol (>1.401 0. SBP/DBP.16 ± 0. mmHg.mmol/L Mean ± SD Patients at goal. n (%) Patients at goal.2 72 (42%) 9. <4.mmol/L Mean ± SD Patients at goal. n (%) LDL-Cholesterol.7% 409 (95%) Number (%) of documentation in file 430 (100%) 430 (100%) 171 (40%) All 430 (100%) 52 ± 12 11. <5.860 0.M A NDH AR I. <6.515 0.099 0. 34 . < = 120/< = 80 Total Cholesterol.43 204 (98%) 145 (69%) p-value 0. IBR AHI M AL-Z AK WANI.78 82 (41%) 74 (37%) 1. <4.mmol/L Mean ± SD Patients at goal.4-< = 10. < = 135.945 0.mmol/L Mean ± SD Patients at goal.522 0. 4.0% HbA1c. LDL-cholesterol.849 0.mmol/L Mean ± SD Patients at goal. >0.657 0.7 ± 2. %.4%) *** Male 167 (39%) 53 ± 12 11.76 ± 1. SBP/DBP (< = 130/< = 80 mmHg).0% HbA1c. mmHg.60 ± 1. LDL-cholesterol (<3.1 .80.92 148 (75%) 75 (38%) 25 (13%) 1. %. MOH A MMED AL-SH AFAEE AND NIC HOL A S WO ODHOUSE Table 1: Demographic.022 0. <8. ***Only 6 (out of 249 diabetic patients = 2. n (%) SBP/DBP. n (%) Patients at goal.309 0.821 0.46 50 (40%) 31 (25%) 1.59.947 0.44. <2.020 0.9 ± 3. >1.020 0. blood pressure and lipid profiles of the study cohort stratified by gender (n = 430) Characteristic Gender.4%) were within goal of HbA1c (<7.37 ± 1.060 0. n (%) Patients at goal. < = 125/< = 80 SBP/DBP.7 ± 2.5% HbA1c.4 59 (48%) 35 (29%) 23 (19%) 9 (7%) 133 ± 17 92 (58%) 91 (57%) 51 (32%) 51 (32%) 82 ± 9 110 (69%) 77 (48%) 76 (48%) 48 (30%) 48 (30%) 5.412 0. mmHg. and Triglycerides 410 (95%) 409 (95%) 409 (95%) 409 (95%) 409 (95%) 386 (90%) 317 (74%) 324 (75%) 346 (80%) 249 (58%) SD = Standard deviation. and triglycerides (<1. <1. n (%) Patients at goal. <3. n (%) HDL-Cholesterol.7 39 (41%) 9.01 201 (85%) 95 (40%) 3.571 0.68 132 (41%) 105 (32%) 1.55 ± 1.68 ± 1. <7. %. mmHg.12 ± 0.8 ± 4.1 to <1.57 ± 0.<1.9 .4 ± 4.522 0.186 0.264 0. mean ± SD.481 0.2.<1.9 20 (18%) 285 (78%) 8. n (%) Triglycerides.3 87 (45%) 42 (22%) 22 (11%) 4 (2%) 133 ± 17 144 (57%) 144 (58%) 87 (35%) 87 (35%) 82 ± 9 163 (65%) 122 (49%) 122 (49%) 83 (33%) 83 (33%) 5.95 233 (74%) 119 (38%) 46 (15%) 1.481 0.16 326 (84%) 153 (40%) 3.120 0.5 20 (34%) 134 (80%) 8.3 ± 3.5. < = 135/< = 80 SBP/DBP. <6.768 0.149 0.mmol/L Mean ± SD Patients at goal.391 169 (39%) 339 (79%) 317 (74%) Systolic Blood Pressure (SBP).8mmol/L). of non-missing values of HbA1c.238 0.5 ± 2.457 0. OM AYM A EL-SH AFIE.830 0. n (%) HbA1c. mmHg Mean±SD Patients at goal.0 ± 3. %. n (%) Diastolic Blood Pressure (DBP).13.809 0. n (%) Patients at goal. n (%) Patients at goal.38 125 (84%) 58 (39%) 3. diabetic.4-< = 7. n (%) Patients at goal. HDL-cholesterol. n (%) Age. < = 130. < = 80.802 0. % Mean ± SD HbA1c.704 0. total cholesterol (<5.4 146 (46%) 77 (24%) 45 (14%) 13 (4%) 133 ± 17 236 (58%) 235 (57%) 138 (34%) 138 (34%) 82 ± 9 273 (67%) 199 (49%) 198 (48%) 131 (32%) 131 (32%) 5.47 ± 1.41 ± 1. < = 120.05 ± 0.863 0.184 0.35 129 (94%) 89 (65%) Female 263 (61%) 51 ± 11 11.A H ME D A L .40 333 (96%) 234 (68%) 6 (2. n (%) Total no.68mmol/L).3.

links with specialty expertise.05. myocardial infarction and cerebrovascular accidents. assuring high quality care to diabetic patients becomes imperative. LDL <3. total cholesterol <5. and monitoring compliance at the point of care with active followup to ensure the best outcome. Moreover. blood pressure and lipid profiles of the study cohort. 35 .<1. This should be achieved through offering self-management support to patients. This would help in identifying opportunities for improvements thus reducing the social and economic burden of the disease on the society. fasting or random blood sugar and HbA1C levels measured regularly.14 In a study that examined the effect of the Chronic Care Model in a small independent practice.3mmol/L). showed an association with higher levels of process measures and intermediate outcomes for diabetes care.12 The challenge for diabetes care is that treatment of this complex disease requires multiple key processes and resources involving both provider and patient.68mmol/L and triglycerides <1. However. The Chronic Care Model (CCM) provides a blueprinting for changing office systems to improve chronic care. maintaining disease registries. respectively. the role of nurses in diabetes care should be enhanced. systolic and diastolic blood pressure (SBP/DBP) (< = 130/80mmHg). means and standard deviations (±SD) were presented and analyses were conducted using the Student’s t-test. Evidencebased guidelines should be integrated into care. tempered by a recent report form the USA concerning 36 academic. total cholesterol (<5. Therefore.4 %) who achieved internation- ally recognised goals for all 6 diabetes related factors. and supported by provider education. Descriptive statistics were used for the data. Ultimately. Muscat. 79% (n = 339) had either RBS or FBS done according to the records.4% (6 out of 249 diabetic patients) that were simultaneously within goal for HbA1c (<7%). HDL-cholesterol.8mmol/L. namely a HbA1C <7. A total of 58% (n = 249) of the patients had nonmissing values of HbA1c. Only 40% (n = 171) and 39% (n = 169) of the diabetics had their random blood sugar (RBS) and fasting blood sugar (FBS) documented.8mmol/L). SBP/DBP. are shown in Table 1. often without major structural change in the practice. The demographic. larger scale studies to assess the quality of diabetes care at the primary. given the high prevalence of diabetes and its complications with the increasing cost of health care services. This retrospective research was done by third and fourth year medical students.68mmol/L). poor control of high blood sugar levels is linked with micro.2mmol/L. For continuous variables. In order to secure quality data collection. renal failure. frequencies and percentages were reported. The overall mean age of the cohort was 52 ± 12 years ranging from 6 to 84 years. total cholesterol.Q UALIT Y OF DI ABETE S CAR E: A C ROSS-SE C TIONAL OBSERVATIONAL ST UDY IN OM AN pressure as well as fasting and/or random blood sugar measurement during the most recent visit. these have direct impact on the economic state of patients and families as well as being a burden on health care systems. and triglycerides (<1.2mmol/L). and reminder systems.and macrovascular complications such as blindness.13 Interventions should focus on patient education. university. LDL-cholesterol. BP ≤130/80. there were only 2.3mmol/L.<1. secondary and tertiary health care institution levels are recommended. Nutting et al. Documentation for the other measurements ranged from 74% (n = 317) for HbA1c and LDL-cholesterol to 95% (n = 409) for blood pressure readings. R E S U LT S A total of 430 diabetic subjects were included in the study from six health centres in various sections of the capital city. the students were supervised by the first author after a three day training course on how to extract data from patient records. 5-11 Our disappointment is.1 .0%. stratified by gender. the proportion of those meeting the expected goals of risk factor control was much lower. however. training of primary care physicians and other patient care providers in behavioural change and redesign of local systems of delivering care. non-general practice clinics who reported a success rate of only 10% in achieving these goals. and triglycerides. HDL-cholesterol >1. Differences between groups were analysed using Pearson’s χ2 tests (or Fisher’s exact test for cells less than 5). More disappointing was the very low number of those (6 out of 249 = 2.1 . however. Just over 61% percent of the subjects were females (n = 263). An a priori two-tailed level of significance was set at 0. DISCUSSION More than 70% of the patients had their blood pressure. For categorical variables. diabetic.15 CONCLUSION In conclusion. Furthermore. HDL-cholesterol (>1. LDL-cholesterol (<3. Overall.

Diabetes care 2000. 3. From http://www. Cagliero E. age. who were involved in the data collection. 352:837-53. Meigs JB. Grant RW. Muscat: Ministry of Health. et al. et al. Nelson CC. Quality of diabetes care in the US academic medical centers. Brown JB. 290:1884-90. racial/ethnic. Harris SB. 9. socioeconomic. 10. Boyle JP. Meigs JB. 4. Von Korff M. Grant RW. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. Barry MJ. 28:337-442. JAMA 2004. physician and systemic factors in the management of type 2 diabetes mellitus. Grant RW. 23:S1-116. Diabet Med 2004. Baydoun M. Diabetes Care 2005. Gaede P. Austin BT. Crabtree BF. low rates of medical regimen change. Manag Care Q 1996. The obesity epidemic in the United States . 291:335-42. Vedel P. 29:6-28.A H ME D A L . Dubey AK. Faulds C. 36 . 348:383-93. Sorensen SW. Buse JB. Narayan KM. 19:344-9. 11. Cowie CC. Diabetes Mellitus: Management guidelines for primary health care. Dickinson WP. Fradkin J. Arch Intern Med 2004. 21:150-5. 6. Pirraglia PA. The role of patient. Williamson DF. 4:12-25. Muscat: Ministry of Health.Gender. 13. 7.org/ Accessed January 2008. Amal Al-Nabhani. Trends in complexity of care from 1991 to 2000 for patients with diabetes. 14. Singer DE. American Diabetes Association. OM AYM A EL-SH AFIE. Wagner EH.idf. New Engl J Med 2003. Clinical inertia in the management of type 2 diabetes metabolic risk factors. International Diabetes Federation (IDF). Lancet 1998. Ministry of Health Oman. and geographic characteristics: A systematic review and meta-regression analysis. Saydah S. Use of chronic care model elements is associated with higher quality care for diabetes. King DK.M A NDH AR I. Ministry of Health Oman.eatlas. Larsen N. 2003. Improving outcomes in chronic illness. Diabetes Atlas. Nutting PA. Khalsa Al-Khanbashi. third year medical students at Sultan Qaboos University. Wetmore S. MOH A MMED AL-SH AFAEE AND NIC HOL A S WO ODHOUSE ACKNOWLEDGEMENTS The authors would like to thank the staff at all the health centres who participated in the study as well as Ibtisam Al-Shaili. UK Prospective Diabetes Study (UKPDS) Group. 15. Iman Al-Lawati. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). 12. Clinical practice recommendations 2000. CONFLICT OF INTEREST: None SOURCE OF FUNDING: Sultan Qaboos University REFERENCES 1. Chueh HC. JAMA 2003. Fam Pract 2002. Gildesgame C. 164:1134-9. Webster-Bogaert S. Stewart M. Ann Fam Med 2007. 2nd edition. Wang Y. Annual Health Report. IBR AHI M AL-Z AK WANI. 2005. 2. 8. Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. Dickinson LM. 5:14-20. 5. Thompson TJ. Lifetime risk for diabetes mellitus in the US. Epidemiol Rev 2007.