Sub-Optimal Management of Type 2 Diabetes Mellitus – A Local Audit

Abstract

Background: Despite increased awareness of risk factors for coronary artery disease and randomized trial data supporting comprehensive diabetic care, these risk factors continue to be largely ignored in patients with type 2 diabetes mellitus. Objective: Cross-sectional study to determine the level of control in patients with type 2 diabetes in tertiary diabetes clinics. Methods: Patient demographic, diabetes and cardiovascular disease related (CVD) data was collected from 150 (F:M; 98:52) randomly selected patients with type 2 diabetes mellitus attending the diabetes clinics at the three academic teaching hospitals served by the University of the Witwatersrand. Blood pressure, height, weight, body mass index and waist circumference were measured. Glycated haemoglobin and fasting serum lipid levels were obtained from patient records. Black patients contributed 68%, White 12, 7%, Indian 10, 7% and Coloured 8, 7%. Results: Mean HbA1c for the whole cohort was 8, 7%. Obesity was present in 37, 3%, hypercholesterolaemia in 29, 3% and hypertriglyceridaemia in 45, 3%. Waist circumference was ≥ 80 cm in 98% of the females and ≥ 94 cm in 69% of the males. 127 patients out of 150 (85%) were hypertensive and 74% of these had a systolic blood pressure ≥ 130 mmHg and 84% a diastolic blood pressure ≥ 80 mmHg. 43% of the patients did minimal exercise, 6% smoked and only 51% were on aspirin. Conclusion: Comprehensive diabetic care is still largely lacking despite clinical trial data documenting improved outcomes associated not only with glycaemic control but also with use of antihypertensive, lipid lowering and anti-platelet therapy.