An Internal Audit of Diabetes Care for Type 2 Diabetic Patients in a Public Hospital Diabetes Clinic in Malaysia

Introduction: Earlier studies have identified a gap between guidelines and actual clinical diabetes care in Malaysia.
Objective: We audited the quality of care for patients with type 2 diabetes mellitus (T2DM) attending our diabetes clinic at a public hospital.
Methods: A structured review of the outpatient clinic cards, prescriptions and laboratory results was conducted for patients attending the diabetes clinic at Sibu Hospital in October and November 2014.
Results: For the total of 233 patients who were audited, the levels of fasting blood sugar, blood pressure, body mass index and fasting lipid profile were satisfactory at 99.1%, 99.6%, 92.6% and 99.6% respectively. 79.7% of the subjects had had HbA1c performed at least once over the previous six months. Only 25.8% had annual foot screening, while the eye screening rate was 71.2% and the albuminuria screening rate was 93.6%. For outcome measures, the mean (SD) HbA1c level was 9.2% (1.91%), with 13 patients (6.7%) having HbA1c less than 6.5%; 36.4% of participants achieved BP < 130/80 mmHg; and 69.4% had LDL < 2.6 mmol/L. The majority of the patients were overweight or obese (91.4%).
Conclusions: Overall, the performance of diabetic care processes at our hospital was satisfactory, except for foot examination. The glycaemic and weight control among the subjects were suboptimal and warrant an optimised and comprehensive approach on the part of the management.

Keywords
audit; quality of care; type 2 diabetes mellitus; diabetes clinic; public hospital