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Adherence to Clinical Diabetic Guidelines in a Rural Community Health Clinic

1 August 2005


Context-With an estimated 6.3% of the American population suffering from the diagnosis of diabetes, proper. management and care must be addressed by our nation's healthcare system. Proper disease management includes early recognition as well as adequate adherence to proven diabetic guidelines which reduce diabetic patients' risk of early morbidity and mortality.

Objective- Few studies have been done in rural settings that assess diabetic management to standard diabetic guidelines as well as primary care providers' adherence to these guidelines. This study investigates how close to ADA diabetic guidelines patients at a rural clinic in Eastern Washington are in regards to glycemic control, blood pressure, lipid management and kidney function. It also measures provider compliance to certain screening and preventative services.

Research Design and Methods- A Retrospective chart review, using a convenience sample of 100 randomized patients meeting inclusion criteria from June 1, 2004 to December 31,2004, with a definite diagnosis of Diabetes Type 2 indicated by ICD-9 coding, was performed. Of the 100 randomized patients, 93 met inclusion criteria and their data was studied. Subjects were 45 years of age or greater, had no Axis II mental or social illnesses, and were established patients in family practice, extended hours, or internal medicine. Patient charts and records in the DEMS were used to evaluate percentage of patients meeting glycohemoglobin goals, with total adherence or goal number measuring 100 percent. These numbers were compared with diabetic standards recommended by ADA, and other rural and urban based studies. Blood pressure, lipid management, kidney functions and preventative services were also measured and analyzed.

Results- In this retrospective medical record based study, glycemic control (AIC 7.65 ± 1.65) was consistent with other rural-based study averages and above the national average. Forty-three percent of the diabetic sample met the ADA goal of ~ 7.0 % for glycohemoglobin control. Forty-three percent of the sample met hypertension guidelines with systolic mean of 132.7 ± 20.33 and diastolic mean of 79.29 ± 10.58. Recommended goals of LDL level was met in 46% of the sample with a mean of 106.23 ± 29.52. Ninety percent of the sample met kidney function and micro albumin goals. Monofilament tests . (53%) and yearly retinal exam referrals (55%) were documented and found to be close to other rural averages. Diabetic education was found to be excellent in this sample with 80% receiving yearly documented education.

Conclusions- Adherence to ADA guidelines are suboptimal with patient A1C levels on average higher than goal. Co-morbid conditions are being managed better than studies of similar populations, yet are still suboptimal. Providers are ordering screening tests above rural averages, showing improved preventative thinking. Education is being achieved, making this study unique for rural areas, showing promise for diabetic education programs. Greater efforts are still needed to incorporate education into proper disease management and optimal reduction of objective data that meets proven guidelines.


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