Quality of type 2 diabetes care based on lipids control in Sub-Sahara Africa: a systematic review

Abstract

Background: Diabetes Mellitus is a growing medical concern in Sub-Saharan Africa (SSA). Currently, urbanization and shift in epidemiological patterns are making this condition increasingly prevalent in this developing region.

The quality of care provided to diabetics based on lipid control in Africa may not be optimal. Nevertheless, there is little evidence to support these claims. Systematically assessing and summarizing the existing literature related to quality of care for patients with type 2 diabetes mellitus (T2DM) was necessary, while also identifying any gaps in information and exploring possible barriers to care in an SSA context.

A systematic overview of the available evidence on diabetes care in this region will be able to help policy makers and health care providers make well-informed decisions.

Aim and Objectives: By addressing the following questions, the systematic review examined the existing management of type 2 diabetes in sub-Saharan Africa:
i. How good is the current control of type 2 DM in SSA based on indicator outcome of lipid levels?
ii. Have implemented strategies, treatment or interventions improved the outcome of type 2 DM in Sub-Saharan African countries?

Methods: A systematic review of quantitative studies was carried out. It was done on a population of people with type 2 diabetes in sub-Saharan Africa. We considered all ages, gender, ethnicities, racial -backgrounds, migration statuses, education levels, and socio-economic backgrounds. In addition to cross-sectional, experimental and quasi-experimental studies, observational studies and reviews were also included. The review focused exclusively on full papers and not abstracts. Conference proceedings, editorials, and case reports were not included in the review. Search strategies were developed using two databases - MEDLINE via Pubmed (1946 to February 2013) and EMBASE via Ovid (1974 to April 2013). Search strategy included lipids, cholesterol, and lipoproteins, as well as terms related to these. Reference lists from derived papers were searched and experts contacted. As the primary outcome of interest, we extracted and summarized data on lipid control measures. Process-related outcomes, such as frequency of lipid level documentation, were secondary outcomes. Duration and complications as related to lipids control of diabetes were also considered.
Also assessed were the interventions or implementation approaches used in the studies or the data collected. Study quality was assessed using the Effective Public Health Practice Project's quality assessment tool.

Results: The review identified and included ten published studies. These were all cross-sectional studies. Interventions focused on diabetes management and preventing complications were the most consistent, followed by drug treatment, then dietary measures. Target levels of total cholesterol were not met in 18% to 43% of patients across studies. 66.1% to 73.5% of patients did not meet the target levels of LDL-C while 35% to 85% of patients did not meet target levels of HDL-C. 40% to 60% of patients did not meet target levels of triglycerides.

Conclusion: The quality of care for type 2 diabetes in sub-Saharan Africa is sub-optimal based on lipid control. Consequently, quality of care needs to be improved in this region. The quality of care in this region is likely to be improved by a variety of interventions, mainly secondary prevention strategies, and implementation strategies. The local population would benefit from targeted interventions and strategies. A consideration of factors impeding quality of care must also include barriers to good diabetes management