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Jun 13, 2017Article Details
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Main Article Content
Standards of diabetic care successes and failures of a patient education policy
Abstract
Objective. To determine: (i) some aspects of the quality of medical care provided for adult diabetic patients in primary care settings; and (ii) changes in these variables 1 year after attending a specialist diabetes clinic that provided 2 - 3 hours of self-care education.
Design. An analysis of the prevalences of obesity, uncontrolled diabetes, hypertension and hypercholesterolaemia at entry and 1 year later.
Setting. Diabetes Clinic, Johannesburg Hospital, South Africa.
Patients. Ninety randomly selected adult diabetic patients (46 black), with duration of diabetes ≥1 year at the first assessment.
Results. At entry insulin-treated (N = 46) and non-insulintreated (N = 44) subjects showed prevalences of obesity (body mass index > 30) of 17% and 36%, respectively; there was unsatisfactory glycaemic control (haemoglobin A1C ≥ 9.5%) in 72% and 64%; untreated hypertension (blood pressure > 160/90 mmHg) in 24% and 23%; and untreated hypercholesterolaemia (> 7.0 mmol/l) in 15% and 11%. One year later weight had increased only in the non-insulintreated patients (+ 1.9 kg, P < 0.01). Mean HbA1C had improved (P < 0.D1 in both groups), but remained unsatisfactory in 49% of patients. Blood pressure control was poor in 14 of the 22 hypertensive patients; and hypercholesterolaemia persisted in 11 subjects. At presentation the patterns of poor control were similar in black and white patients, and the rates of improvement were comparable.
Conclusion. There was a low rate of overall metabolic control of diabetes and its associations in primary care settings, with only limited improvements as a result of attending a dedicated diabetes clinic.
