A critical review of whether goals for treatment in type 2 diabetes mellitus as set out by the 2012 Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) guidelines are being achieved in patients attending the diabetic clinic at Helen Joseph Hospital

Abstract

A dissertation submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in fulfilment for the requirements of the degree of Master of Medicine. Johannesburg, 2018.Background The risk of complications from T2DM is high. Complications reduce quality of life and place a large burden on our health system and economy. Achieving targets in our diabetic patients significantly reduces the morbidity and mortality of the disease. This study aims to assess whether patients at the Helen Joseph Academic Hospital Diabetic Clinic are meeting the 2012 SEMDSA targets for diabetes with the current hospital treatment protocols. Methods A Retrospective Clinical Audit was carried out at the Helen Joseph Hospital Diabetic Clinic. The files of 321 patients with T2DM for a duration of longer than five years and who were on insulin were reviewed. The following information was assessed: Glycated haemoglobin (HbA1c), Blood pressure, abdominal circumference and lipograms. Results The study population of 321 patients compromised majority black (44.6%) and coloured (34%) patients. The mean age amongst these patients was 59.4 years. This sample was predominantly female (62.3%). A large proportion of patients had concomitant Hypertension (89.1%) and dyslipidaemia (82.2%); with 91.2% fulfilling criteria for the diagnosis of metabolic syndrome. The majority of patients 56.3% did not exercise. A small amount partook in recreational activities that increase cardiovascular risk (smoking 12.5% and alcohol use 10.6%). Target HbA1c used for the purpose of this study was 7% or lower. The mean HbA1c in this study population was 9.5% (range 3.9 – 16.9%). Only 15.3% achieved the 7% target. The number of patients who achieved the target Blood Pressure of <140/90 was 72 (25%) (95% CI 20.2-30.5). LDL target was achieved in 22.6% and abdominal circumference 11%. Conclusions Despite adequate protocols and access to tertiary medical care, only a very small percentage of patients at the diabetic clinic are achieving proposed targets. Other audits have revealed a range of reasons for poor control in their patients. More comprehensive analysis is required to assess the reasons in this clinic if we are to address the problem with the urgency it requires. Ultimately, the goal is to offer the best treatment and quality of life to our ever increasing diabetic population.LG201