A mixed-methods needs assessment of adult diabetes mellitus (type II) and hypertension care in Toledo, Belize

Abstract

BackgroundNon-communicable diseases, including diabetes mellitus and hypertension, continue to disproportionately burden low- and middle-income countries. However, little research has been done to establish current practices and management of chronic disease in these settings. The objective of this study was to examine current clinical management and identify potential gaps in care of patients with diabetes mellitus and hypertension in the district of Toledo, Belize.MethodsThe study used a mixed methodology to assess current practices and identify gaps in diabetes mellitus and hypertension care. One hundred and twenty charts of the general clinic population were reviewed to establish disease epidemiology. One hundred and seventy-eight diabetic and hypertensive charts were reviewed to assess current practices. Twenty providers completed questionnaires regarding diabetes mellitus and hypertension management. Twenty-five individuals with diabetes mellitus and/or hypertension answered a questionnaire and in-depth interview.ResultsThe prevalence of diabetes mellitus and hypertension was 12%. Approximately 51% (n = 43) of patients with hypertension were at blood pressure goal and 26% (n = 21) diabetic patients were at glycemic goal based on current guidelines. Of the patients with uncontrolled diabetes, 49% (n = 29) were on two oral agents and only 10% (n = 6) were on insulin. Providers stated that barriers to appropriate management include concerns prescribing insulin and patient health literacy. Patients demonstrated a general understanding of the concept of chronic illness, however lacked specific knowledge regarding disease processes and self-management strategies.ConclusionsThis study provides an initial overview of diabetes mellitus and hypertension management in a diverse patient population in rural Belize. Results indicate areas for future investigation and possible intervention, including barriers to insulin use and opportunities for lifestyle-specific disease education for patients.

Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent

“…A few studies in our review reported a low prevalence of diabetes among some indigenous populations in LatAm [55,74,82], in parallel to some previous reports [283][284][285][286] about other indigenous groups in the region and in contrast with the higher prevalence of diabetes among American Indians in the USA [287] and the First Nations in Canada [288]. However, other studies in our review and in the current literature have documented elevated diabetes prevalence or risk among indigenous and other socioeconomically disadvantaged ethnic groups [48,50,73,76,77,83,90,91,166,[289][290][291][292][293]. Some of the diabetes prevalence studies included in our review focused on or mentioned participants from indigenous groups [35,48,50,74,83] and other underrepresented groups (e.g., Garifuna, Afro-Panamanian, Afro-Peruvian, Afro-Ecuadorian) [55,76,90,91,166].…”

“…However, other studies in our review and in the current literature have documented elevated diabetes prevalence or risk among indigenous and other socioeconomically disadvantaged ethnic groups [48,50,73,76,77,83,90,91,166,[289][290][291][292][293]. Some of the diabetes prevalence studies included in our review focused on or mentioned participants from indigenous groups [35,48,50,74,83] and other underrepresented groups (e.g., Garifuna, Afro-Panamanian, Afro-Peruvian, Afro-Ecuadorian) [55,76,90,91,166]. However, a few studies have evaluated diabetes care, prevalence, and/or prevention of macro-or microvascular complications, diabetes management interventions, other health care needs and access to health care among indigenous populations [241,244,246,[294][295][296][297][298][299][300][301][302], and none on the other groups (that we could identify through our search).…”

Assessment of Patient Counselling in Diabetic and Hypertensive Patients in Terms of Patient Knowledge About Their Medication, Disease State and Lifestyle Modifications by Pharmacy Personnel at LDF Clinic in Maseru

“…Also, our study showed that the mean FBG level was high for diabetic patients meaning glycaemic control was poor among diabetic patients even though they were taking anti-diabetic medicines. Our findings were consistent with those in a study by Dekker et al which showed that inadequate glycaemic control was present in 74% of all diabetic patients [15]. Additionally, a study by Nepal et al conducted in Nepal revealed that among 89 type 2 diabetic respondents only 27 (30.34%) had normal FBG level [16].…”

Barriers and facilitators to successful management of type 2 diabetes mellitus in Latin America and the Caribbean: A systematic review

“…Regarding “knowledge” (30 studies) [ 27 , 29 – 31 , 34 , 35 , 38 , 39 , 41 , 43 , 46 , 50 – 52 , 58 , 62 , 65 , 67 , 70 – 73 , 75 , 80 – 86 ], the authors recognised the importance of both patient and professional’s knowledge. Lack of professional knowledge was identified as a factor associated with miscommunication and poor management of the side effects.…”