Quality of diabetes care in low- and middle-income Asian and Middle Eastern countries (1993–2012) – 20-Year systematic review

• Systematic compilation large number of studies on quality of care of diabetes.
• Reveals important deficiencies in quality of care of diabetes and areas to be addressed.
• This review may stimulate more audits and uniformity of measures used.

ObjectiveTo assess the extent to which people with diabetes in low- and middle-income countries (LMIC) of Asia and the Middle East met evidence-based care recommendations through a systematic review of published literature.MethodsElectronic searches of Medline and Embase were carried out for studies assessing quality of care among people with diabetes in Asia and the Middle East between 1993 and 2012. Benchmarking against American Diabetes Association guidelines, we reported level and proportions meeting recommended risk factor control (glycated hemoglobin [HbA1c], blood pressure, and low density lipoprotein-cholesterol [LDL]) and preventive care processes across different settings.ResultsOne hundred and fifteen publications met eligibility for inclusion (91 reported risk factor control, 7 reported preventive processes, and 17 reported both). Only China, Thailand, Malaysia and Philippines had nationally representative data. Mean HbA1c (6.5–11% or 48–97 mmol/mol), SBP (120–152 mm Hg), and LDL (2.4–3.8 mmol/l) varied greatly. Despite variation in availability of data, studies consistently showed that recommended care goals were not being achieved.ConclusionsThe practice of auditing and benchmarking against evidence-based guidelines appears to be uncommon in Asia and the Middle East and there was heterogeneity of reporting across studies, populations, and methods used. The available data showed inadequate care.