Does good clinical practice at the primary care improve the outcome care for diabetic patients? Gender differences

Background: The Middle East region is predicted to have one of the highest prevalence of diabetes mellitus (DM) in the world. This is the first study in the region to assess treatment outcome of DM according to gender. Objective: To assess the quality and effectiveness of diabetes care provided to patients attending primary care settings according to gender in the State of Qatar. Design: It is an observational cohort study. Setting: The survey was carried out in primary health care (PHC) centers in the State of Qatar. Subjects and methods: The study was conducted from January 2010 to August 2010 among diabetic patients attending (PHC) centers. Of the 2334 registered with diagnosed diabetes, 1705 agreed and gave their consent to take part in this study, thus giving a response rate of 73.1%. Face to face interviews were conducted using a structured questionnaire including socio-demographic, clinical and satisfaction score of the patients. Results: Majority of subjects were diagnosed with type 2 DM (84.9%). A significantly larger proportion of females with DM were divorced or widowed (9.1%) in comparison to males with DM (3.4%; p < 0.001). A significantly larger proportion of females were overweight (46.5%; p = 0.009) and obese (29.5%; p = 0.003) in comparison to males. Males reported significantly greater improvements in mean values of blood glucose (mmol/l) (-2.11 vs. -0.66; p = 0.007), HbA1c (%) (-1.44 vs. -0.25; p = 0.006), cholesterol (mmol/l) (-0.16 vs. 0.12; p = 0.053) and systolic blood pressure (mmHg) (-9.04 vs. -6.62; p < 0.001) in comparison to females. While there was a remarkable increase in male patients with normal range of fasting blood glucose (FBG; 51.6%) as compared to the FBG measurement 1 year before (28.5%: p < 0.001) there was only a slight increase in females normal range FBG during this period from 28.0% to 30.4% (p = 0.357). Conclusion: The present study revealed that the current form of PHC centers afforded to diabetic patients provided significantly improved outcomes for males, but only minor improved outcomes for females. This study reinforces calls for a gender-specific approach to diabetes care. (C) 2012 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.