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首页> 外文期刊>Global journal of medicine and public health. >Improving diabetes care in Northern Haiti
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Improving diabetes care in Northern Haiti

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AimsWe attempted to improve clinical outcome measures (HbA1c, blood pressure, preventive foot care) in a highrisk population of diabetic patients living in Northern Haiti.MethodsWe enrolled patients followed at the Justinian University Hospital’s Diabetes Clinic, who qualified by havingeither a HbA1c 9 (75 mmol/mol) or blood pressure 160/95. Culturally-appropriate educational materialswere used to instruct patients and providers, and evidence-based algorithms for the management of glycemia,blood pressure and foot care were utilized.ResultsDespite delays due to a serious earthquake, cholera and political unrest, we enrolled a total of 101 patients.Despite high rates of adoption of study protocols, we saw no improvement in HbA1c (pre- 10.8 ± 0.27, 95 ± 2.9mmol/mol, vs post- 10.8 ± 0.33, 95 ± 3.6 mmol/mol), systolic (144 ± 3.3 vs 143 ± 3.7 mmHg) or diastolic (89 ±1.9 vs 87 ± 1.8 mm Hg) blood pressure. Focus group discussions identified the lack of food and money as themajor barriers to patients’ self-management of diabetes. There was a common belief that psychologicalstressors were the cause of diabetes. We found no evidence that traditional healers (dòktè fèy) or spiritualbeliefs (vodou) worked in opposition to medical care.ConclusionsEfforts to translate evidence-based clinical algorithms into improved clinical outcomes may be ineffective infragile states such as Haiti unless food scarcity and extreme poverty are first addressed.

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