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Quality of Diabetes Care in the Middle- and High-Income Group Populace

The Delhi Diabetes Community (DEDICOM) survey

From the Sitaram Bhartia Institute of Science and Research, New Delhi, India

Address correspondence and reprint requests to Abhishek Bhartia, Director, B-16, Qutab Institutional Area, New Delhi 110016. E-mail: abhishek.bhartia{at}sitarambhartia.org

OBJECTIVE—We sought to evaluate the quality of care in known diabetic patients from the middle- and high-income group populace of Delhi.

RESEARCH DESIGN AND METHODS—A cross-sectional survey was conducted using a probability proportionate to size (systematic), two-stage cluster design. Thirty areas were selected for a house-to-house survey to recruit a minimum of 25 subjects (known diabetes 1 year; aged 35–65 years) per area. Data were collected by interview, by blood sampling, and from medical records.

RESULTS—A total of 819 subjects (of 1,153 eligible) were enrolled from 20,666 houses. In total, 13.0% (95% CI 9.6–17.3) of the patients had an HbA_1c (A1C) estimation and 16.2% (13.5–19.4) had a dilated eye examination in the last year, 32.1% (27.5–36.6) had serum cholesterol estimation in the last year, and 17.5% (14.2–21.5) were taking aspirin. An estimated 42.0% (37.7–46.2) had an A1C value >8%, 40.6% (36.5–44.7) had an LDL cholesterol level >130 mg/dl, and 63.2% (59.6–66.6) had blood pressure levels >140/90 mmHg.

CONCLUSIONS—A wide gap exists between practice recommendations and delivery of diabetes care in Delhi.

Abbreviations: DEE, dilated eye examination • DQIP, Diabetes Quality Improvement Project • DSD, duration since diagnosis • NDQIA, National Diabetes Quality Improvement Alliance • OHA, oral hypoglycemic agent • PCP, primary care provider • SMBG, self-monitoring of blood glucose

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