Improving Diabetes Care: A Fijian Diabetes Service Improvement Study

Table 1

Measures for evaluating optimal management. Description of optimal diabetic management as per the Fijian diabetes guidelines [16].

Evaluation area	Recommendations as per guidelines
Targets for glycemic control
RBS
Good control (optimal control)	4-8 mmol/L
Fair control (suboptimal control)	8.1-10 mmol/L
Poor control	>10-14 mmol/L
Worse control	≥14 mmol/L
HbA1c
Good control	<6.5%
Fair control	6.5-7.5%
Poor control	>7.5%
Glycemic management
No ODA	Dietary advice
Single ODA	MTF or SU
Combination ODA	MTF + SU
Dosing of oral drugs
Minimum	Level 1 dosing
Metformin 250 mg-1 g/day
Glipizide 5-12.5 mg/day
Glibenclamide 2.5-7.5 mg/day
Moderate	Level 2 dosing
Metformin 1 g-2 g/day
Glipizide 12.6-20 mg/day
Glibenclamide 7.6-15 mg/day
Maximum	Level 3 dosing
Metformin >2 g/day
Glipizide >20 mg/day
Glibenclamide >15 mg/day
Combination ODA dosing levels
Level 1	Minimum dose of 2 drugs
Level 2	Moderate dose of 2 drugs or 1 moderate dose and 1 minimum dose
Level 3	Maximum dose of 2 drugs or 1 maximum dose and the other drug with moderate or minimum dose
Using HbA1c tests	Every 6 months
MDT assessments	(i) Foot assessment referral and foot risks classification-yearly; (ii) Eye assessment-yearly; (iii) Dietician referral

ODA: oral drug administration; SU: sulphonylurea; MTF: metformin.