Are We Treating the Right People? Are We Treating the People Right? Health Status, Knowledge and Quality of Life amongst Patients with Diabetes at a Specialized Clinic at Kamuzu Central Hospital, Malawi

Aims: To describe health status, knowledge and quality of life among patients with diabetes mellitus attending a tertiary hospital in the capital of Malawi.

Study Design: A cross-sectional observational study among randomly selected adult patients with diabetes.

Place and Duration of Study: Diabetes clinic, outpatients department, department of Medicine, Kamuzu Central Hospital, Lilongwe, Malawi between April 2014 and May 2014.

Methodology: We included 271 randomly selected patients (82 men, 189 women; age range 18-86 years) with diabetes mellitus. Socio-demographic characteristics, clinical status, glycosylated hemoglobin (HbA1C), comorbidities and medical history were assessed beside diabetes specific knowledge and subjective quality of life (QoL).

Results: There were 77% classified as having type 2 diabetes vs. 23% type 1 diabetes. In 4% tuberculosis (TB) was suspected and prevalence of human immunodeficiency virus (HIV) was 13.6%. Level of education was high in 52%. Mean HbA1C was 7.1% and 15.9% had an HbA1c <5.5%. HbA1C was significantly higher in type 1 vs. type 2 diabetes (P <.001). Mean body mass index (BMI) was 30.1 kg/m2. The mean BMI for females 31.4 kg/m2 (SD 5.9) was significantly higher than that for males 26.9 kg/m2 (SD 4.6), (P = .001). Arterial hypertension was diagnosed in 61% and 52% had a systolic blood pressure >= 140 mmHg and/or diastolic blood pressure >= 90 mmHg. Among all participants, 23% had estimated glomerular filtration rate (eGFR) corresponding to stage 3 and above chronic kidney diseases (CKD). The majority of patients (62%) could not name their diabetes type or causes; 75% of participants expressed a significant fair overall QoL.

Conclusion: The clinic was dominated by well-educated adipose females with relatively adequately controlled HbA1c and patients, who might have no diabetes. Patients with acute metabolic diabetes complications were underrepresented. Subjects showed a fair subjective QoL. Clinic function and focus as a specialized tertiary care center require re-definition.