Assessment of diabetes care in Saudi Arabia
: by analysis of routine healthcare data, patient case notes and interviews with key stakeholders

  • Abdullah Alshehri

    Student thesis: Doctoral ThesisDoctor of Philosophy


    Diabetes is a major public health problem in Saudi Arabia. One fifth (20%) of the Saudi population has diabetes and their healthcare takes almost a quarter (23%) of the total healthcare expenditure. A few sporadic small studies showed some evidence of suboptimal diabetes care.

    The aim of this study was to identify the deficiencies in diabetes care and the potential areas for quality improvement of service provision in Abha, a city representative of Saudi Arabia.

    A programme of research was undertaken using multiple research methods: semi-structured interviews with key stakeholders encompassing patients, healthcare professionals, managers and pharmacists; standard checklist for evaluating available resources; analysis of routine healthcare data; questionnaires to medical directors and healthcare leaders; and examination of the case notes of patients with diabetes.

    The local registered diabetes prevalence was found to be lower than the national estimate (3.75% versus 14-25%). Almost three quarters (73%) of people with diabetes in Abha city have not been diagnosed. The vast majority (85%) of adult people with diabetes were either overweight or obese.

    Reviewing case notes of patients with diabetes at the primary health care centres (PHCCs) showed that only 4% had a record of HbA1c test and most patients (77%) did not achieve the recommended target of FBG of = 130 mg/dl (=7.2 mmol/l). Almost half the patients exceeded (47%) the recommended level of total cholesterol of = 195 mg/dl (5 mmol/l). Screening for diabetes complications is inadequate: foot examination was done for only 5.5%, neuro-examination for 37% and eye examination for 52%. Some medications e.g. mixed insulin and statins were not consistently available and inadequacies were identified in the provision of healthcare staff (e.g. dieticians and podiatrists) and laboratory resources (e.g. HbA1c test). Limited attention was given to health education and concerns were expressed about patient compliance. These findings were consistent across the multiple methods used.

    This study in Abha city found that a large number of Saudi patients with diabetes are not achieving recommended levels of glycemic, lipid and body mass index (BMI) control and are therefore at high risk of diabetes complications. Inadequate provision of laboratory facilities, drugs and patient education programmes compound these problems. Recommendations are made for strategies to improve both the structure and processes of diabetes care and the healthy behaviours of people with diabetes.
    Date of Award2014
    Original languageEnglish
    SupervisorIain Crombie (Supervisor) & Linda Irvine (Supervisor)

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