To determine differences in the control of multiple diabetes control parameters in a select group of subjects with type 2 diabetes (T2DM) after a four-year follow-up period. Design: Cross-sectional study. Setting and subjects: The initial 2009 study population consisted of 666 T2DM patients of whom only 261 (39.2%) were audited at the Charlotte Maxeke Johannesburg Academic Hospital. Outcome measures: Using a public sector database, retrospective data were obtained on the treatment of participants with T2DM attending a tertiary care setting and a descriptive analysis was done. Results: The mean age was 64 (SD 10.6) years, women represented 55% of the cohort and the mean duration of diabetes was 16 years (range 2-40 years) in 2013. Fewer patients achieved an HbA1c goal (of < 7%) in 2013 (15.5%) compared with 2009 (25.4%), whilst an additional 13.7% and 25.0% of the 261 patients reached blood pressure targets (< 140/80 mmHg) and LDL-C targets (< 2.5 mmol/L), respectively. Conclusion: Overall, more patients in the study reached blood pressure and LDL-C targets but there were difficulties in achieving optimal glycaemic levels over the four-year period. This study highlights the complexities of managing risk factors in T2DM, especially glucose control.
PurposeOur study set out to examine if disparities in control of glycated hemoglobin (HbA1c), blood pressure (BP), and low-density-lipoprotein cholesterol (LDL-C) existed among an urban multi-ethnic cohort of South Africans, living with type 2 diabetes mellitus (T2DM).Patients and methodsThis longitudinal, retrospective study consisted of 261 men and women with previously diagnosed T2DM who attended Charlotte Maxeke Johannesburg Academic Hospital, South Africa across two time periods 2009 and 2013. Demographic and clinical data were extracted from consecutive medical records. The primary outcome was to determine achievements in HbA1c, BP, and LDL-C among ethnic groups using evidence-based goals.ResultsThe mean age of the cohort was 64 (±10.6) years, females represented 55%, and the self-reported diabetes duration was 16 (±10.6) years as at 2013. Black Africans (42.9%, n=112 of 261) were more likely to reach the HbA1c target (<7%) and less likely to have had retinopathy, nephropathy, or cardiovascular disease. Over two-thirds of mixed-ancestry patients attained the BP target (<140/80 mmHg), while 90.2% of Caucasians achieved LDL-C goals (<2.5 mmol/L). Overall, across the ethnic groups studied, we found that HbA1c control deteriorated over time, although BP levels remained the same and LDL-C levels drastically improved.ConclusionThere was poor control of HbA1c, BP, and LDL-C across all ethnic groups. Although a minority achieved recommended targets, some ethnic groups appeared to have worse control than others. Timely aggressive actions in particularly high-risk ethnic groups will prevent/delay the complications commonly associated with T2DM.
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