These findings highlight a frequently observed trend seen with diabetes care in low-resource settings where logistical challenges have a dramatic negative impact on the care of diabetes patients [2, 23C25]. Our investigation has several limitations which are important to highlight. by evaluating different facets of the operation of the clinic and their accordance with the Rabbit Polyclonal to ELAC2 International Diabetes Federation (IDF) guidelines. Results A total of 524 patients were enrolled into the diabetes clinic during the predefined period of evaluation. The overall clinic population demonstrated a statistically significant reduction in HbA1c and point of care blood glucose at all time points of evaluation after baseline. Patients had a mean baseline HbA1C of 10.2% which decreased to 8.4% amongst the patients who remained in care after 18?months. In terms of process measures, STING agonist-1 38 patients (7.3%) were characterized as being lost to follow up as they missed clinic visits for more than 6?months. Through the assessment of structural metrics, the clinic met at least the minimal standards of care for 14 out of the 19 domains recommended by the IDF. Conclusion This analysis illustrates the gains made in various elements of diabetes care quality which can be used by other programs to guide diabetes care scale up across the region. Electronic supplementary material The online version of this article (10.1186/s12902-018-0324-5) contains supplementary material, which is available to authorized users. value ?0.05. STATA 13.1(College Station, TX, USA) was used for all analyses. Results 524 patients were enrolled in the WDH diabetes clinic between July 2009 and September 2011. Median age was 58?years (IQR?=?19) with only 14 patients (3% of the population) having an age??20?years and 56% being female. The median diabetes duration prior to enrolment was 4?years. Baseline mean BMI of the male and STING agonist-1 female participants were 26.0?kg/m2 (SD?=?9.0) and 27.6 (SD?=?6.5) STING agonist-1 kg/m2, respectively. 27% (Standard Error of the Mean, Standard Deviation, Interquartile range Table 2 – Duration of Follow-up for Diabetes Clinic Patients Self-Monitored Blood Glucose Clinical outcomes Mean HbA1c decreased from a baseline of 10.2% by 10% for each subsequent clinic visit compared to the enrolment HbA1c. This reduction was statistically significant for each interval comparison for the SMBG group, the non-SMBG group (usual clinic care), and for the overall group. Significance was primarily driven by patients with higher baseline HbA1c ( ?10%) who showed a statistically significant mean decrease of 31.6% at 12?months, while patients with an HbA1c between 7 and 10% showed a modest and non-significant mean decrease in HbA1c of 2.7%. Participants in the SMBG group had the highest baseline HbA1C at 12.4% and showed the largest drop after 3?months of care to 9.6% (Table?3). Table 3 – Mean HbA1c at quarterly intervals within the overall, self-monitored blood glucose and regular clinic populations Standard Deviation *Random Blood Sugar, Body Mass Index *P? ?0.05 via paired t test comparing baseline values in each column to subsequent values Statistically significant reductions were not seen with systolic or diastolic blood pressure from the baseline mean blood pressure of 134/83?mmHg. Minimal and non-significant changes in the mean BMI were seen throughout the periods of evaluation. Among individuals with a baseline BMI ?18.5?kg/m2, BMI increased over time to a mean BMI of 20?kg/m2 by month 18 (Table?5). Table 5 – Progression of BMI based on initial BMI classification body mass index * em P /em ? ?0.05 via paired t test comparing baseline values in each column to subsequent values In terms of diabetes complications, participants in both the SMBG and regular care groups demonstrated high initial frequencies at enrolment of peripheral neuropathy manifested primarily through foot symptoms, ocular complications, hypoglycemia, and hyperglycemia, which declined over time as illustrated in Table?6. Table 6 – Diabetes associated complications in the self-monitored blood glucose vs regular care groups thead th rowspan=”2″ colspan=”1″ Time /th STING agonist-1 th colspan=”5″ rowspan=”1″ Self-monitored blood glucose /th th colspan=”5″ rowspan=”1″ Regular Care /th th rowspan=”1″ colspan=”1″ N /th th rowspan=”1″ colspan=”1″ Peripheral neuropathy events (n,.