Quality Indicators for Diabetes Care in Practice Guidelines and Applying in the District Hospital

Main Article Content

Utoomporn Parinyasakulwong
Thananan Rattanachotphanit
Onanong Waleekhachonloet
Chulaporn Limwattananon
Sumon Sakolchai
Denpong Patanasethanont


This study had two main objectives. The first objective was to conduct a systematic document review to identify and summarize quality indicators of diabetes care. An electronic search of English and Thai language literature published between 1990 and 2008 was performed. Eleven established guidelines were included. Thirty-eight indicators were extracted and categorized into eight diabetes management topics: glycemic control, nephropathy assessment, lipid profile assessment, eye examination, foot examination, blood pressure control, antiplatelet use, and others. The secondary objective was to perform a cross-sectional study to describe the quality of diabetes care in term of process and outcome in two district hospitals in Amnatcharoen Province. All diabetic patients who had fasting blood sugar (FBS) monitored at least three times per year during the period 2003 to 2007, were analyzed by hospital electronic database and medical chart review. In 2003, 2004, 2005, 2006, and 2007, there were 759, 991, 1,212, 1,389, and 1,481 diabetic patients, respectively. The proportions of serum creatinine and lipid profile monitoring increased gradually over time whereas HbA1c and proteinuria monitoring was performed in a small number of cases. The hospitals began to provide complete foot examinations in 2007 and nearly half of patients were examined. The percentage of the patients receiving eye examinations varied over the years. The proportion of patients who were prescribed angiotensin-converting enzyme inhibitors improved substantially between 2003 (17%) and 2007 (49%), whereas most patients were not prescribed aspirin and statins during these years. The percentage of the patients who reached the American Diabetes Association (ADA) 2004 goals of therapy for FBS and blood pressure were relatively low over the five year period. In conclusion, most processes of diabetes care were improved over the five year period. However, there is still room for improvement in the quality of diabetes care in district hospitals. Appropriate management programs should be implemented to improve diabetes care.

Article Details



Aekplakorn W, Stolk R, Neal B, Suriyawongpaisal P, Chongsuvivatwong V, Cheepudomwit S, et al. The prevalence and management of diabetes in Thai adults: the international collaborative study of cardiovascular disease in Asia. Diabetes Care 2003; 26(10): 2758-63.

American Diabetes Association. Standards of medicalcare in diabetes fi 2004. Diabetes Care 2004;27 (suppl 1): s15-s35.

Chetthakul T, Pongchaiyakul C, Tandhanand S. Improvement of diabetic care at Maharat Nakhon Ratchasima Hospital (the study of Diabcare-Asia from 1997 to 2003). J Med Assoc Thai 2006; 89(1): 56-62.

Chin MH, Auerbach SB, Cook S, Harrison JF, KoppertJ, Jin L, et al. Quality of diabetes care in community health centers. Am J Public Health 2000; 90(3): 431-4.

Nicolucci A, Greenfield S, Mattke S. Selecting indicators for the quality of diabetes care at the health systems level in OECD countries. Int J Qual Health Care 2006; 18 (Suppl 1): 26-30.

Nitiyanant W, Chetthakul T, Sang AP, Therakiat-kumjorn C, Kunsuikmengrai K, Yeo JP. A survey study on diabetes management and complication status in primary care setting in Thailand. J Med Assoc Thai 2007; 90(1): p. 65-71.

Putzer GJ, Ramirez AM, Sneed K, Brownlee HJ, Roetzheim RG, Campbell RJ. Prevalence of patients with type 2 diabetes mellitus reaching the American Diabetes Association’ s target guidelines in a university primary care setting. South Med J 2004; 97(2): 145-8.

Rawdaree P, Chardpraorn N, Deerocha-nawong C, Suwanwalaikorn S, Chettha-kul T, Krittiyawong S, et al. Thailand Diabetes Registry (TDR)Project: Clinical status and long term vascular complications in diabetic patients. J Med Assoc Thai 2006; 89: 1-9.

Rujirawat P, Rattanachotphanit T, Limwattananon C, Chirakup S, Chaiyakunapruk N, Roze S, et al. Cost-effectiveness Analysis of type 2diabetes disease management in district hospital context: An analysis using CORE diabetes model. IJPS 2007; 3: 78-93.

Saaddine JB, Cadwell B, Gregg EW, Engelgau MM, Vinicor F, Imperatore G et al. Improvements in diabetes processes of care and intermediate outcomes: United States, 1988-2002. Ann Intern Med 2006; 144(7): 465-74.

Spann SJ, Nutting PA, Galliher JM, Peterson KA, Pavlik VN, Dickinson LM et al. Management of type 2 diabetes in the primary care setting: a practice-based research network study. Ann Fam Med 2006; 4(1): 23-31.

Taweepolcharoen N, Sumrithe S, Kunentrasai Nand Phraisuwanna S. Diabetes control in a university primary care setting in Thailand. Qual Prim Care 2006; 14(4): 219-24.