Abstract
Objective: To assess the standard of care provided to the diabetic patients by physicians as per
American Diabetes Association (ADA) guidelines at tertiary centers of Karachi, Pakistan.

Method: This cross sectional study was conducted on type 2 diabetic patients visiting two
tertiary care hospitals of Karachi, over a period of six months (June to December 2012). All
adults of either gender with the history of diabetes for more than 5 years were included. A
structured questionnaire was used to collect data from patients. Data was analyzed with SPSS
version 19.

Results: A total of 250 patients were included in this study in which, 102(40.8%) had their
regular follow up while 148(59.2%) were irregular in their follow up. Regular patients
maintained their blood sugar levels with mean HbA1c of 6.99±0.13, whereas irregular patients
had mean HbA1c levels of 7.25±0.16. Only 162(64.6%) patients had dietary advice and 11 (6.7%) were referred to a dietitian. Eighty eight (35.2%) patients did not receive any dietary advice. BMI of 156(62.4%) patients ranged from 27.3-30.2 and thus were categorized as obese, however weight reduction and walking was advised in only 127(88.4%) patients. Smoking cessation was advised to 122(88.4%) out of 138 smokers. Regular foot care was advised to only 72(28.8%)
individuals and just 4(5.5%) were referred to chiropodist. 70(28%) patients had ocular
complaints and thus had their eye examined, whilst 180(72%) never had an eye examination. For nephropathy screening, urine for proteinuria was checked in 154(61.6%) patients on their first
visit and annually in 96(38.4%) patients. Lipid profile for dyslipidemia was advised in 172(68.8%) patients at their first visit and annually in 78(31.2%) patients.

Conclusion: This study concluded that the care provided to our diabetic population is inadequate and ADA guidelines are not being followed optimally.

Key words: Body mass Index BMI, proteinuria, dietitian, ophthalmologist, dyslipidemia