Assessment of clinical characteristics, complications And gaps encoutered in management of diabetic Patients on follow up at outpatient diabetic clinic of Jumc, southwest ethiopia

Abstract

BACKGROUND- Diabetes is increasing at alarming rate in low-and middle-income countries due partly to rapid urbanization, lifestyle changes, and limited resources and diabetes care in such resource limited countries is far below standards. The management gaps of diabetic patients in JUMC are not well known. OBJECTIVES- The aim of this study was to assess the clinical characteristics, complications and gaps encountered in management among diabetic patients on follow up at outpatient diabetic clinic of Jimma University Medical Center, South-West Ethiopia. METHODS-Hospital-based cross-sectional study was conducted on patients consecutively selected from those who were attending the diabetic clinic at Jimma University Medical Center from September 1 to November 30, 2020. Patients age of 18 years and above were included. Socio-demographic characteristics and diabetic related information was collected from 272 selected patients consecutively by using structured questionnaires. Chart of the patients was reviewed for type of diabetes, diabetic complications, diabetic medication and laboratory results. Data were entered into Epidata software 3.1 version and exported to SPSS version 25.0 software for analysis. RESULTS-The mean +/-SD of the study participants were 50+/-15 years with female to male ratio of 1:1.5. Type 2 diabetes found in 220 (80.9%) of patients and 200(73.5%) of the patients had fasting blood sugar of above 130mg/dl (poor glycemic control). The common symptoms at time of disease onset were polyuria and polydipsia 216(79.4%). Hypertension was the most common comorbid disease 128 (47%) and 121(94.5%) of them were type 2 diabetes. One hundred seventy-five (64.3%) of the patients had at least one diabetic complication and 114 (72.6%) were type 2 diabetes. One hundred fifteen (65.7%) patients had diabetes for more than five years. Diabetes ketoacidosis was the most common acute complication 54 (19.9%) of which 41(76%) of the patients were type 1 diabetes. Peripheral neuropathy 71(26.1%), retinopathy 32 (11.7%), nephropathy 23 (8.4%) and coronary heart disease/stroke 19 (7%) were the common chronic microvascular and macrovascular complication. Only 65 (23.9%) were doing vigorous/moderate physical exercise and 108 (39.7%) of the patients were obese/overweight. Thirty-nine (14.3%) and 82 (30.1%) had HbA1C and lipid profile results respectively. Regarding diabetic education 213 (78.3%), 209 (76.8%) and 109 (40.1%) of patients had no explanation about diabetic treatment during illness, home blood glucose measurement and on blood glucose measurement techniques respectively and most of the managing physician were junior residents and General Practitioner at diabetic clinic. CONCLUSION- The overall diabetes care at the hospital was far below recommended guidelines. To prevent or delay diabetes related complication, managing patients based on standard diabetes guideline at least with the resource what we have is crucial.