Diabetes Care Urban India - Sitaram Bhartia Hospital

Study Overview : DEDICOM

Evaluating the Real-World Quality of Diabetes Care in Delhi

This study presents a comprehensive evaluation of the quality of diabetes care (QOC) among patients in Delhi using data from the DEDICOM-II community survey.

Unlike facility-based studies, this research captures real-world care delivery across diverse socio-economic groups, reflecting how diabetes is actually managed outside structured healthcare systems.

It provides critical insights into:

Glycaemic, blood pressure, and lipid control
Adherence to recommended clinical practices
Gaps in preventive and monitoring care

The study highlights the disconnect between established clinical guidelines and real-world practice, offering a clear picture of care delivery at the population level.

The Problem

A Widening Gap Between Guidelines and Care Delivery

Despite well-established standards for diabetes management, their translation into routine care remains significantly deficient, especially in low- and middle-income settings.

Key challenges include:

Poor adherence to evidence-based clinical guidelines
Lack of routine monitoring and preventive assessments
Fragmented healthcare delivery systems
High dependence on general practitioners with variable expertise
Limited access to comprehensive diabetes care facilities

In India, community-level data on quality of care is scarce, making it difficult to measure performance, identify gaps, and drive improvement.

Objective

Assessing Quality of Care in Real-World Settings

The primary objective of the study is to:

Evaluate the quality of diabetes care in known patients
Measure adherence to
- Clinical guidelines
- Monitoring protocols
- Preventive care practices
Assess:
- Glycaemic control
- Blood pressure and lipid management
- Process-of-care indicators

The study aims to generate representative, community-level evidence to inform healthcare improvements.

Study Design & Methodology

A Cluster-Randomized Community Survey Approach

Intervention:

Existing patterns of care delivery
Clinical management practices
Preventive care adherence

The study was conducted using a two-stage cluster randomized sampling design across Delhi.

Key Methodology Elements:

30 clusters selected from 150 wards (Probability Proportionate to Size)
House-to-house survey across selected colonies
Inclusion:
Adults aged 35–65 years
Known diabetes ≥1 year
Sample size:
843 participants
800 with laboratory data

Data Collection Included:

Key Methodology Elements:
30 clusters selected from 150 wards (Probability Proportionate to Size)
House-to-house survey across selected colonies
Inclusion:
Adults aged 35–65 years
Known diabetes ≥1 year
Sample size:
843 participants
800 with laboratory data

This methodology ensures representative, population-level insights into diabetes care quality.

Outcome Measures:

Clinical Outcomes

Glycaemic control (HbA1c levels) , Blood pressure control, Lipid profile management

Process-of-Care Outcomes

Frequency of:
- HbA1c testing, Eye examination, Foot examination, Lipid testing
Medication use:
- Oral drugs, insulin, Aspirin, Lipid-lowering therapy Composite Quality Indicators
ABCD control:
- HbA1c, Blood pressure, Cholesterol, Smoking status