Assessment of Quality of Diabetic Care in Teaching Hospitals in Ethiopia: In Comparison to International Guidelines

Figures & data

Table 1 Socio-Demographic Characteristics of Diabetic Patients in Yekatit 12 Hospital, Addis Ababa

Characteristic’s	Frequency	Percentage
Sex
Male	109	43.6
Female	141	56.4
Age(yrs.)
18–44	67	26.8
45–60	103	41.2
>60	80	32.0
Marital status
Single	35	14.0
Married	144	57.6
Divorced	24	9.6
Widowed	47	18.8
Educational level
No formal education	46	18.4
Primary school	46	18.4
Secondary school	98	39.2
College/university	60	24.0
Occupation
Government employee	41	16.4
Private	82	32.8
Retired	38	15.2
House wife	71	28.4
Others*	18	7.2
Income(ETB)
Less than 1500	56	22.4
1500–5000	133	53.2
5000–10,000	31	12.4
Above 10,000	30	12.0

Note: *No job, students.

Table 2 Comorbidities and Medications Used Among Adult Diabetic Patients at Yekatit 12 Hospital Medical College, Addis Ababa

Characteristics	Frequency	Percentage
Types of Diabetes Mellitus
Type 1 DM	42	16.8
Type 2 DM	208	83.2
Duration
1–5yrs	94	37.6
5–10yrs	78	31.2
>10yrs	78	31.2
Family history of DM	103	41.2
Comorbidity	168	67.2
Hypertension	144	57.6
Heart failure	30	12.0
HTN and Heart failure	17	6.8
CKD	16	6.4
CKD and HTN	13	5.2
Others(*)	16	6.4
Consuming Alcohol	77	30.8
Smoking
Current smoker	9	3.6
Ex-smoker(>1yr)	6	2.4
Non-smoker	235	94.0
Regular exercise	161	64.4
Diabetic drugs used
Metformin	158	63.2
Insulin	139	55.6
Metformin and insulin	48	19.2
Sulfonylureas	44	17.6
Metformin and sulfonylureas	43	17.2
DPP4 inhibitor or SGLT2 inhibitor	4	1.6
Adherence to diabetic drugs
Missed dose per week	41	16.4
Not missed dose in a week	209	83.6
Other drugs
Antihypertensive (ACEI/ARB, CCB, Thiazide)	143	57.2
Statin	97	38.8
Aspirin	47	18.8
Others(**)	44	17.6

Notes: *Stroke, HIV, Asthma) **(Propylthiouracil(PTU), furosemide, antiretroviral drugs(ART).

Abbreviations: DDP4, dipeptidyl peptidase-4; SGLT2, Sodium-glucose cotransporter-2; ACEI, Angiotensin-converting enzyme inhibitors; CCB, Calcium channel blocker.

Table 3 Result of Diabetic Quality of Care Indicator as Referenced to the International Guideline, Yekatit 12 Hospital, Addis Ababa

Description	Quality Performance Indicators n(%)	Standard (ADA, IDF)
The proportion of patients with BP measurement in each visit	247 (98.8)	BP should be measured at each visit
The proportion of hypertensive patients with SBP<130 and DBP<80	133 (53.2) and 123 (49.2)	BP<130/80 for high cardiovascular risk
The proportion of patients with HbA1C at least twice in the past one year	84 (33.6)	HbA1C should be measured at least twice per year
The proportion of diabetic patients with HbA1c<7%	52 (40.6)	HbA1c goal for adult <7%
The proportion of patients with at least one retinal examination in the last year	122 (48.8)	The retinal examination is recommended yearly
The proportion of patients with urine albuminuria tests in the last year	52 (20.8)	Urine albuminuria and eGFR at least annually, bi-annually for CKD/albuminuria
The proportion of patients with at least one lipid profile in the last one year	28 (11.2)	Annual lipid profile
LDL value below 100mg/dl, n-28	12 (42.9)	LDL target <100mg/dl

Abbreviations: HbA1c, glycated hemoglobin; eGFR, Estimated glomerular filtration rate; BP, Blood pressure; SBP, Systolic blood pressure; DBP, Diastolic blood pressure.

Figure 1 Level of HbA1c level among diabetic patient, Yekatit 12 Hospital, May–July 202.

Table 4 Bivariate and Multivariate Logistic Regression Analysis of Factors Associated with Glycemic Control Among Diabetic Patients in Yekatit 12 Hospital, Addis Ababa

Variables	HbA1c Control		COR95% CI	P-value	AOR95% CI	P value
	Yes	No
Marital status
Single	10 (62.5)	6 (37.5)	5 (1.27, 19.7)	0.02	5.76 (1.2, 32.35)	0.047
Married	32 (42.1)	44 (57.9)	2.18 (0.78, 6.12)	0.14	1.27 (0.36, 4.47)	0.70
Widowed	4 (33.3)	8 (66.7)	1.5 (0.33, 6.82)	0.60	2.49 (0.33, 15.93)	0.34
Divorced	6 (25)	18 (75)	1
Educational status
Illiterate	10 (47.6)	11(52.4)	1
Primary school	7 (30.4)	16 (69.6)	0.48 (0.48, 1.65)	0.95	0.57 (0.12, 2.63)	0.47
Secondary school	18 (36.7)	31 (63.3)	0.64 (0.23, 1.78)	0.17	0.28 (0.07, 1.13)	0.07
College and above	17 (48.6)	18 (51.4)	1.03 (0.35, 3.1)	0.28	0.49 (0.12, 1.93)	0.30
Duration
1–5yrs	18 (36)	32 (64)	1		1
5–10yrs	15 (38.5)	24 (61.5)	1.11 (0.47, 2.64)	0.81	1.12 (0.37, 3.50)	0.89
Above 10yrs	19 (48.7)	20 (51.3)	1.69 (0.72, 3.96)	0.23	2.76 (0.90, 8.34)	0.07
Alcohol use
Yes	14 (31.1)	31 (68.9)	1		1
No	38 (45.8)	45 (54.2)	1.87 (0.87, 4.01)	0.11	1.46 (0.54, 3.92)	0.45
Regular exercise
No	11 (25.6)	32 (74.4)	1		1
Yes	41 (48.2)	44 (51.8)	2.7 (1.21, 6.07)	0.02	2.69 (0.93, 7.71)	0.065
Frequency of HbA1c/year
< 2times	8 (18.2)	36 (81.8)	1		1
At least twice	44 (52.4)	40 (47.6)	4.95 (2.06, 11.9)	0.001	6.27 (2.17, 17.73)	0.001
Drug adherence
Not <7day/week	16 (24.2)	50 (75.8)	1		1
Yes −7day/week	36 (58.1)	26 (41.9)	4.33 (2.03, 9.21)	0.001	7.1 (2.61, 19.01)	0.001

Abbreviations: AOR, adjusted odd ratio; COR-crude odd ratio, CI; confidence interval.