The implementation of guidelines in a South African population with type 2 diabetes

Abstract

Objective: The aim of this study was to identify the treatment gaps that pertain to risk factors in South African patients with type 2 diabetes mellitus, using national treatment guidelines.
Design: Cross-sectional study.
Setting and subjects: The study consisted of 666 patients with type 2 diabetes mellitus, attending a diabetes clinic at the Charlotte Maxeke Johannesburg Academic Hospital.
Outcome measures: Using a public sector database, retrospective data were obtained on the treatment of type 2 diabetes mellitus participants. Patients were randomly selected on the basis of established type 2 diabetes mellitus diagnosis, and if they were receiving oral hypoglycaemic and/or insulin therapy. Age, gender, race, blood pressure, haemoglobin A_1c (HbA_1c) and fasting lipids were captured and measured. The history of patients’ previous coronary artery disease, strokes, nephropathy, neuropathy and retinopathy was recorded.
Results: The mean age of the patients was 63 years [standard deviation (SD) 11.9], 55% of whom were females. The HbA_1c was 8.8% (SD 2.5). 26.2% of patients attained HbA_1c levels of < 7%. Of the total patients, 45.8% met a < 130/80 mmHg blood pressure target, and 53.8% a low-density lipoprotein (LDL) cholesterol of < 2.5 mmol/l. Only 7.5% obtained the combined target for HbA_1c , blood pressure and LDL cholesterol.
Conclusion: Traditionally, type 2 diabetes mellitus treatment has centred on correcting blood glucose levels. Yet, as many as 80% of people with type 2 diabetes mellitus die from some form of cardiovascular disease  (CVD). Many trials have demonstrated the benefits of targeting CVD risk factors (HbA_1c, blood pressure and lipids) in patients with type 2 diabetes mellitus. Despite the wealth of evidence, our data suggest that significant undertreatment of risk factors in patients with type 2 diabetes mellitus remains.

Keywords: diabetes mellitus, risk factors, targets, management