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 (FM; 9852) 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; 7and Coloured 8; 7. Results: Mean HbA1c for the whole cohort was 8; 7. Obesity was present in 37; 3; hypercholesterolaemia in 29; 3and hypertriglyceridaemia in 45; 3. Waist circumference was = 80 cm in 98of the females and = 94 cm in 69of the males. 127 patients out of 150 (85) were hypertensive and 74of these had a systolic blood pressure = 130 mmHg and 84a diastolic blood pressure = 80 mmHg. 43of the patients did minimal exercise; 6smoked and only 51were 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