Alphabet strategy for diabetes care: A checklist approach in the time of COVID-19 and beyond

Table 1 Comparison of achievement of alphabet strategy components between practices of evidence-based medicine audits[10]

Alphabet strategy		Baseline audit, n = 420	Follow-up audit, n = 1071	P value
A	Smoking status (%)	15.5	14.7	0.83
B	Blood pressure (mmHg)	141/77	136/76	0.007
C	Total cholesterol (mmol/L)	4.9	4.5	< 0.001
	LDL cholesterol (mmol/L)	2.5	2.4	< 0.001
	Creatinine (mmol/L)	109	105	0.036
D	HbA1c (%) (mmol/mol)	8.3 (67.2)	7.9 (62.8)	0.09
E	Eye examination (%)	95.5	97.1	0.72
F	Foot examination (%)	83.5	97.3	< 0.001
G	Aspirin (%)	83.5	88.0	0.20
	ACEI/ARB (%)	73.0	74.4	0.75
	Lipid lowering (%)	55.0	73.4	< 0.001

Follow-up audit was done 2 years later. ACEI: Angiotensin converting enzyme inhibitors; ARB: Angiotensin receptor blockers; LDL: Low-density lipoprotein.

Table 2 Change in care process performance following implementation of the alphabet strategy in a low-resource diabetes clinic[10]

		Pre implementation (%)	Post implementation (%)	P value
A	Body mass index	99	99	NS
	Smoking status	99	99	NS
	Smoking cessation	100	100	NS
B	Blood pressure	99	99	NS
C	Total cholesterol	60	99	< 0.001
	Lipid profile	10	64	< 0.001
	Creatinine	5	49	< 0.001
	Proteinuria	48	93	< 0.001
D	Fasting and postprandial glucose	41	97	< 0.001
E	Eye examination	98	100	NS
F	Feet examination	95	100	NS
G	Aspirin therapy	6	71	< 0.001
	ACEI/ARB therapy	7	57	< 0.001
	Statin therapy	5	38	< 0.001
	All three	2	20	< 0.001

NS: Not significant; ACEI: Angiotensin converting enzyme inhibitors; ARB: Angiotensin receptor blockers.