Assessing predictors for sustainable management of type 2 diabetes using evidence-based guidelines in public primary care in a predominantly Afro-Caribbean population.

PURPOSE: The purpose of our study was to assess the success in the public primary health care clinics in Barbados, a developing nation with a predominantly Afro-Caribbean population, of achieving the targets for the management of type 2 diabetes (T2D) set by local guidelines introduced in 2006. The targets are: A1C < 6.5% (48 mmol/mol), blood pressure (BP) ≤130/80 mm Hg and LDL cholesterol < 1.8 mmol/L.

METHODS: A retrospective descriptive chart review of 499 (317 females, 182 males) T2D patients using random quota sampling.

RESULTS: Only 41.2% (Men 48.3%, women 36.8%, P = .048) of the patients reached the A1C target, 39.3% (men 48.6%, women 34.0%, P = .002) reached BP target and 8.6% (men 10.8%, women 7.3%, P = .24) reached the LDL target and only 1.2% (n = 3) attained all three targets.

CONCLUSION: Similar to other studies in developed and developing countries of varying ethnic composition, there was suboptimal attainment of the defined targets for all parameters and inadequate monitoring. The main predictors affecting the attainment of treatment goals were the frequency of monitoring, duration of the disease, sex and ethnicity related factors. Interestingly, the findings support a possible viewpoint that ethnicity, defined by an interplay of genetics, culture and environmental attributes, is not the single most important predictor for poor target attainment in T2D. The low attainment of the targets emphasizes the question of less rigorous and more individualized treatment to achieve better outcomes in a developing territory as recommended by the 2014 guidelines.