Diabetes care and complications in primary care in the Tshwane district of South Africa

Abstract

Aims: To describe the diabetic population receiving primary care from the Tshwane district public health services and to assess the quality of care of members of this population, their level of disease control and the extent of their complications. Methods:A cluster-randomised trial was conducted in 12 primary care clinics in Tshwane district. A total of 599 diabetic patients attending these clinics for review were consecutively interviewed and clinically examined. Data on the care received was also obtained from their clinical records for the previous 12 months. Patients randomised to the active arm of the study were screened for complications. Results:The mean age was 58 years and 80.5% had a body mass index (BMI) ≥ 25kg/m 2 . Sixty-eight percent of patients were female. Acceptable glycaemic control and LDL-cholesterol were found for only 27% and 33% of patients respectively (HbA1c<7%; LDL <2.5 mmol/l). Despite more than 79% of patients reporting to be hypertensive, 68% of patients had a systolic blood pressure above 130 mmHg and 64% had a diastolic blood pressure above 80 mmHg. Evaluating patient records of the preceding year, screening for eye complications was only reported in 8.2%, feet complications in 6.5%, kidney complications in 21.4% and cardiovascular complications in 7.8%. The screening prevalences found were 29% for retinopathy, 22% for maculopathy, 5% for neuropathy (neurothesiometer), 7% for nephropathy (eGFR stage3-5), 17% for possible infarction (Rose questionnaire) and 36% for severe erectile dysfunction (SHIM questionnaire). Conclusion:Diabetes care and screening for complications at primary care level in the Tshwane district were found to be sub-optimal. Measures should be taken to address this.

Diabetic nephropathy in a tertiary care clinic in South Africa: a cross-sectional study

“…Webb respectively. 13 However, Gill et al recorded a lower mean SBP (108 mmHg) and mean DBP (72 mmHg) than that in this study. 16 In the present study, 84.4% of the patients were overweight, including 55.2% who were obese.…”

“…There were uncontrolled lipids in more than 80% of their study population. 13 In this study, the mean SBP was 140 mmHg and the mean DBP 80 mmHg. More than half of the patients (54%) had a DBP above the target recommended by the 2012 SEMDSA guidelines.…”

“…Webb et al found similar levels of obesity in their study, where more than 80% of patients were overweight. 13 One of the limitations of the present study was that it was a tertiary, clinic-based study. The study population was mostly patients who were difficult to control at a lower level of care, and who were therefore referred to the tertiary clinic.…”

“…Webb et al found that more than 70% of patients had an HbA 1c value > 7% in a cluster randomised trial conducted in the Tshwane district. 13 73.8% of patients failed to meet the HbA 1c target in another study conducted in a South African population with type 2 diabetes.…”

“…However, diabetes control was also shown to be suboptimal in two other studies conducted in South Africa. 13,14 The first study was on diabetic patients attending primary healthcare clinics, but the study population from the second study presented at a diabetic clinic in a tertiary academic hospital similar to ours, after being referred by their treating physicians at the primary clinics. 13,14 The prevalence of micro-or macroalbuminuria in patients with type 1 and type 2 diabetes was 33.6%; 23% for microalbuminuria and 10.6% for macroalbuminuria, in this cross-sectional analysis.…”