A five-year evaluation of intervention in diabetes care in Trinidad and Tobago

Aims To evaluate an intervention to improve diabetes care in government-run heath centres an Trinidad and Tobago over 5 years. Methods A cross-sectional survey of 690 subjects with clinical diabetes att ending nine health centres was carried out in 1993. The intervention was: r eports to the Ministry of Health, dissemination of management guidelines an d annual training workshops for healthcare staff. Re-evaluation was through a survey of 1579 subjects with diabetes, attending 23 health centres in 19 98. Results Comparing 1993 with 1998, foot examinations in the previous year in creased from 38 (6%) to 346 (22%) and fundoscopy from 6 (1%) to 139 (9%). F or subjects attending for 1 year or less, 34/96 (35%) had dietary advice re corded in 1993 compared with 77/143 (54%) in 1998. Exercise advice was reco rded for 3/96 (3%) in 1993 and 48/143 (34%) in 1998. In 1993, 329 (48%) wer e taking chlorpropamide but this fell to 57 (4%) in 1998. Glibenclamide use increased from 214 (31 %) to 856 (54%) and gliclazide from four (1%) to 20 5 (13 %). In 1993, 198/338 (56%) of hypertensive subjects were taking Brine rdin, this fell to 56/829 (7%) in 1998 while use of thiazide diuretics, met hyldopa and angiotensin-converting enzyme (ACE) inhibitors increased. There were no changes In indicators of metabolic control, blood pressure control or body weight. Conclusions Use of audit data to inform health policy and practice, linked with educational interventions, may modify patterns of care in government-r un primary care health centres in a middle-income country with a high preva lence of diabetes.