Are type 2 diabetic patients meeting targets? A Helen Joseph Hospital Diabetic Clinic Audit

Abstract

The risk of complications from type 2 diabetes mellitus (T2DM) is high. Achieving targets reduces the morbidity and mortality. This study aims to assess whether patients at the Helen Joseph Hospital's Diabetic Clinic are meeting the 2012 SEMDSA targets for diabetes. Methods: A retrospective clinical audit was carried out. The files of 321 patients with T2DM were reviewed. Glycated haemoglobin (HbA1c), blood pressure, abdominal circumference and lipograms were assessed. Results: The study population comprised majority black (n = 143; 44.6%) and coloured (n = 109; 34%) patients and was predominantly female (n = 200; 62.3%). The mean age was 59.4 years (SD 9.9 years). In total, 89.1% (n = 286) had hypertension, and 82.2% (n = 264) dyslipidaemia. The metabolic syndrome criteria were fulfilled by 266 (91.2%) patients. The majority did not exercise (n = 174; 56.3%). A small number smoked (n = 39; 12.5%) and used alcohol (n = 33; 10.6%). Mean HbA1c was 9.5% (SD 2.4; range 3.9-16.9%). Only 49 (15.3%) achieved the target HbA1c. Target blood pressure was achieved by 72 patients (25%). LDL target was achieved by 71 (22.6%) and abdominal circumference by 32 (11%) patients. Conclusions: Despite adequate protocols and access to tertiary medical care, a very small percentage of patients are achieving proposed targets. The reasons for this are likely multi-fold and further analysis is required to assess these.

Suboptimal control for patients with type 2 diabetes in the Central Chronic Medicine Dispensing programme in South Africa

“… 16 , 17 , 18 , 33 In contrast to other studies that reported poorer outcomes, more than half of the patients in this study (57.4%) achieved their BP targets. 17 , 18 , 34 In a review of 14 studies from 19 different countries, BP control is often the least-achieved target. 32 This may be because treating diabetes-associated risk factors, including hypertension, is inadvertently under-emphasised.…”

“…Similar to other studies focussing on patients with type 2 diabetes in the South African primary healthcare sector, the patients in this study were predominantly African and women, with a reported mean age of 53.0–59.4 years. 16 , 17 , 18 , 24 …”

“… 16 The results of this study confirmed poor glycaemic control amongst patients with type 2 diabetes in South Africa, with only 29.2% of patients achieving control. 16 , 17 , 18 , 24 This is concerning because to be eligible for enrolment in the CCMDD programme, these patients should have been stable controlled patients. The fact that the largest proportion of patients had not achieved glycaemic control indicates that access to medicines is not the only factor influencing glycaemic control in this population.…”

“…Similar to other studies focussing on patients with type 2 diabetes in the South African primary healthcare sector, the patients in this study were predominantly African and women, with a reported mean age of 53.0-59.4 years. 16,17,18,24 Historically, glycaemic control has been suboptimal in South Africa's primary healthcare sector. 25,26 In this study, the proportion of patients who reported HbA1c values as a measure of glycaemic control were quite high (72.7%) compared with those in other South African studies 24,27 and were similar to glycaemic testing rates reported in a dozen of primary healthcare facilities in the Tshwane district.…”

“…13,14 Despite clear professional guidelines such as those provided by the Society for Endocrinology, Metabolism and Diabetes South Africa (SEMDSA) 2017, 15 glycaemic control is often suboptimal or poor in South Africa. 16,17,18,19,20 This is concerning because people with poorly controlled diabetes may require greater medical intervention if they acquire viral infections, including the novel coronavirus disease 2019 (COVID- 19), and poorly controlled type 2 diabetes is associated with a higher death rate amongst COVID-19 patients. 21 In this article, we describe the clinical outcomes of patients with type 2 diabetes who are enrolled in the CCMDD programme in the City of Tshwane.…”