An audit of structure, process and outcome of care of the diabetic clinic, National Hospital of Sri Lanka.

AIMS: To audit the structure, process and outcome of care. SETTING: The diabetic clinic, National of Hospital Sri Lanka (NHSL). METHODS: A previously validated MCQ paper of 10 questions which assessed knowledge of diabetes on insulin therapy, dietary management, management during acute illness and management of emergencies was administered to all patients. The function of the clinic was assessed using previously validated audit case record forms. MEASURES OF OUTCOME: Diabetes knowledge among patients, waiting times, bypassing of local institutions, availability of diagnostic equipment, screening activities and time spent for consultation. RESULTS: The clinic had a daily average attendance of 186 patients seen between 0800 to 1200 hours. A single medical officer spent 2.1 minutes for each patient. No screening was performed. There were no facilities to examine patients or for them to sit during consultation. The diabetes knowledge score was 15.1 (SD 3) from a maximum score of 40.43% had bypassed a local institution. Reasons for bypass included non-availability of drugs and the expectation of quality care at NHSL. Patients spent a mean of 1.5 (SD 0.7) hours travelling to the clinic and waited a mean of 1.56 (SD 0.4) hours to see the doctor and 1.3, (SD 0.12) hours to obtain drugs. CONCLUSIONS: The services of the diabetic clinic do not meet the standards expected of a clinic at a tertiary referral centre. Lack of planning and resources (space, manpower and management skills) can be identified as principal shortcomings.

Patient mixed biphasic insulin in a diabetic clinic.

INTRODUCTION: Improved glycaemic control is possible with the use of multiple injections of premixed insulin. These are expensive, and not available in state hospitals. OBJECTIVES: To study the cost, patient acceptance and efficacy of a patient mixed and administered combination of soluble and lente (biphasic) insulin administered twice a day. PATIENTS: A cohort of 25 patients with poor glycaemic control on a single dose of 100 units or more of lente insulin. 25 patients matched for age and glycaemic control were used as a control. SETTING: The diabetic clinic of the National Hospital Sri Lanka. METHOD: A prospective study of a cohort of patients. RESULTS: Mean fasting blood glucose decreased from 8.3 mmol/l (SD 3.1) to 6.9 mmol/l (SD 2.3, p < 0.01) and mean blood glucose levels declined from 12.3 mmol/l (SD 4.1) to 10.1 mmol/l (SD 4.7, p < 0.01) in the biphasic group. Total mean insulin dose fell from 80 units (SD 12) to 61 units (SD 11) in the biphasic group, but increased in the control group from 82 units (SD 16) to 91 units (SD 13.1). The diabetes well-being score in the biphasic group was 91.5 (SD 35.3), while the control group had a score of 63.7 (SD 21.3 p < 0.01). Mean glycosylated haemoglobin (HbA1c %) was 8.1 (SD 2.7) in the biphasic group compared to 9.2 (SD 3.3) in the control group. CONCLUSION: Patient mixed and administered biphasic insulin on a twice daily basis is feasible, acceptable to patients, results in better glycaemic control and affords better patient satisfaction.