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VOLUME 14 NUMBER 1 • JULY 2017
DIABETES CARE MODEL
SA JOURNAL OF DIABETES & VASCULAR DISEASE
The purpose of having data boxes in the program was for ease of
use and to speed up the process of data capturing. Numerical data
entries are needed for the following:
• year of first diagnosis of DM
• cluster of differentiation (CD4) count
• sitting and erect BP
• resting pulse rate
• RBG
• height/weight/BMI/waist circumference.
A second page in the program was created to allow the user to
capture blood results with the date that the blood is drawn. The
purpose of entering dates for each set of blood results is that the
initial blood results can be used as a baseline with which to compare
future results. The program allows the user to enter multiple blood
results that are found in the file, each with its own date. This allows
collection of a complete history of patients’ blood results. Blood
results that cannot be found in the patient’s chart are traced on the
National Health Laboratory Service (NHLS) website.
For eye assessments, the program was designed to allow the
user to choose Yes/No for the following:
• glaucoma
• cataracts
• proliferative retinopathy
• non-proliferative retinopathy.
If the user entered ‘Yes’ to any one or more of the above for eye
assessment, the program then enquired whether it was right, left
or bilateral.
Once again a separate page in the program was created for ECG
analyses. The following is required for every ECG:
• axis: data box options under this include right, left or normal
• ventricular hypertrophy: data box options include right, left and
none
• bundle branch block (BBB): data box options here include RBBB,
LBBB, left anterior fascicular block, left posterior fascicular
block, bifasicicular block, none
• evidence of previous MI: if ‘Yes’, then the following boxes will
open:
- inferior territory MI
- anterior territory MI
- lateral territory MI
- anterolateral territory MI
- none.
The program was designed to interpret and group the various leads
into inferior, anterior, lateral or anterolateral territories.
• premature ventricular contractions: data box for Yes/No
• atrial fibrillation or atrial flutter: data box for Yes/No
• T-wave abnormalities: if ‘Yes’, data box for T-wave inversion or
peak T-waves.
Another tab was created for urine dipstick results and includes the
following parameters:
• date of dipstick
• Yes/No boxes present for each of the following parameters:
- red blood cells
- white blood cells
- protein
- ketones
- glycosuria.
If any of the above boxes are marked as ‘Yes’ then the program
offers the user a range from 1+ to 4+ as tick boxes to enter the
quantity.
For evidence of clinical neuropathy, there are data boxes
for sensory and motor neuropathy. For thyroid examination data,
there are boxes for normal and goitre. For injection site data
the user has choices of normal, lipoatrophy, lipodystrophy or
cellulitis.
With regard to drug prescription, a comprehensive list of
commonly prescribed medications was compiled and captured.
The program gives the user a chance to view the list of medications
alphabetically or use the search function to retrieve the medication,
then to choose the drug and add the dosage (if different from the
dosage already stored on the program). It was recognised that
the program might not list all medications so it was modified to
allow the user to capture a new drug that is not on this list. The
program was designed to allow the user to add to this list of
medications and save these new drugs for future reference.
For data analysis purposes, the programmer was commissioned
to program the various comparisons required for patient and
clinic monitoring and reports were generated by Crystal
®
reports
[SAP SE (Systems, Applications & Products in Data Processing)
Germany]. The comparisons required were decided on based on
clinical requirement for auditing.
In the main menu of the program, an option tab exists for
reports, and within this section various reports are available for
review purposes. Some examples include reports comparing the
type of DM with mean glycosylated haemoglobin achieved, and
reports comparing the number of patients with type 1 and type
2 DM.
Discussion
This integrated approach to DMmanagement within this resource-
limited clinic ensures that all patients consulted at the clinic are
evaluated and managed in a structured and comprehensive
way. DM is a non-communicable disease with devastating
complications if uncontrolled. Complications can be reduced with
adequate control.
1
Local guidelines provide a structured approach
to diabetes management; however, very few clinicians actually
follow these guidelines and this may be one of the reasons why
so few patients achieve targeted control of their disease.
We believe that introducing a multifaceted approach targeting
both the clinician and patient will help improve control in this
regional-level diabetes clinic. The booking system ensures that the
numbers of patients seen at the clinic is regulated (decreased from
60–70 to 30–40 patients per week). Together with the additional
doctors working at the clinic, this means that patients are now
spending more quality consulting time with the clinician. Initially
patients were apprehensive of the longer consultation times and
consulting the various members of the team. However, they soon
realised that the overall benefits they gained outweighed their
increased consulting times.
Patients get the benefit of a fully operational multidisciplinary
team, which includes nursing staff, dieticians, podiatrist, family
and specialist physicians, interns and medical officers. Patient
education is provided by every member of this team. Nursing
staff are trained in weekly special sessions on diabetes care and
management. All clinicians, prior to working in the clinic, are
also trained on diabetes management using the 2012 SEMDSA
guideline. A datasheet was developed and introduced into the
clinic. This datasheet ensures that all diabetic patients receive a
standardised and comprehensive assessment and management
that follows local diabetes guidelines. It also ensures that commonly