What does it mean to our patients?
Presenter: CF Otieno
Affiliation: Department of Clinical Medicine and
Therapeutics,UoN & KNH-Medicine
TYPE 2 DIABETES
 Progressive disease
 Well characterized . . .
 But-poorly controlled
 Broad treatment goals:-
glycaemia,BP,LDL,Weight,Knowledge,Self
management,HRQoL etc
RISK FACTORS OF COMPLICATIONS
Microvascular
Hyperglycaemia
Genetics
(Hypertension)
Macrovascular
Lipids
Hypertension
Genetics
Age
COMPLICATION PROFILES AT KNH
Microvascular
 Eye
 Neuropathy
 Nephropathy
• Microalbuminuria
• Macroalbuminuria
• ESRD
MACROVASCULAR
COMPLICATIONS
 Cerebrovascular disease (Mwazo)
 Myocardial infarction (Nguchu)
(STEMI/NSTEMI)
 Erectile dysfunction (Ngalyuka)
COMPOSITE COMPLICATIONS
 Renal disease
 Diabetic foot ulcer, 7.8%:
 (Diabetes) – Risk factors
 (The patient) – Knowledge, Attitude, Practice
 (The health unit) – Policy
 Foot-at-risk>33%
(Mugambi E, et al)
RISK FACTOR PROFILE AT KNH
 Glycaemic control: <40% good control
 BP control – only 50% known HTN, out of these only
25% well controlled.
 Lipids - high LDL
 Adherence to treatment – POOR
REASONS FOR POOR CONTROL
 Provider factors:
Knowledge, Attitude, Practices, etc
 System factors
 Policies, Medication access, Insulin access
 Patient factors
Knowledge, Attitude, Practices, Socio-Economic
Status
Heterogeneous disease
CONSEQUENCES OF POOR
CONTROL
 Enhanced complications ( at early age)
 Renal
 Cardiac
 Stroke
 Attenuated HRQoL
 Health resource consumption-hospitalization;
dependance.
CAN WE STEM THE TIDE?
 Access to care:
 Policies
 Physical
 Quality of care and evaluation
 Clinical end-points
 Administrative end-points
 Risk stratification of patients?
 Address fatigue of care providers?
AREAS TO ADDRESS
 Health system adjustment: patient-focused decision-
making
 Generate evidence:-longitudinal studies for outcomes;
RCTs etc.
 Cost-related studies-effectiveness and benefit analysis
 MORTALITY reviews
In conclusion, . .
We need to ask ourselves:
 Can we tell whether our patients are better off NOW
than thirty years ago ?
OR
 What ails our patients? What does the care we give
mean to them ?
THANK YOU