Are recommended standards for diabetes care met in Central and South America? A systematic review.

Aims: We evaluated quality of diabetes care in low- and middle-income countries (LMIC) of Central and South America by documenting the ability to meet the guideline-recommended targets. We also identified barriers to achieving goals of treatment and characteristics of successful programs.

Methods: We searched the National Library of Medicine and Embase databases to systematically compile literature that reported on guideline-recommended processes of care (annual foot, eye, urine examinations, and regular blood glucose testing) and risk factor control (glycemic, blood pressure, and lipid levels) among people with diabetes since 1980. We compared risk factor control across clinic and household populations and benchmarked against the IDF guidelines.

Results: The available literature was largely from Mexico, Jamaica, and Brazil with little data from rural regions or smaller countries. Twenty-nine clinic-based and ten population-based studies showed a consistent failure to meet recommended care goals due to multiple underlying social and economic themes. Across all studies, the proportion of those not meeting targets ranged from 13.0 to 92.2% for glycemic control, 4.6 to 92.0% for blood pressure, and 28.2 to 78.3% for lipids.

Conclusions: Few studies report quality of diabetes care in LMICs of the Americas, and heterogeneity across studies limits our understanding. Greater regard for audits, use of standardized reporting methods, and an emphasis on overcoming barriers to care are required.