Type 2 Diabetes Mellitus Management: A Retrospective Study in Rural General Practice

Abstract

Type 2 Diabetes Mellitus (T2DM) is a chronic, progressive metabolic disease that is an international epidemic. General Practitioners (GPs) are the cornerstones of T2DM management. The aim of this study was to determine the scope of care and management of patients with T2DM within General Practice, while highlighting domains of success and areas where improvement can be made. Demographic and laboratory cross sectional data were collected by examining electronic patient records at one rural General Practice to address the aims of the study. Data included key management parameters of Hemoglobin A1c (HbA1c), estimated Glomerular Filtration Rate (eGFR), microalbuminuria, blood pressure and cholesterol levels, in addition to age, sex, and residential postcode. Further, data regarding the use of insulin, antihypertensive medications and lipid-lowering medications were collected and analyzed. Descriptive and inferential statistics were used and significance was determined at p≤0.05. A total of 294 electronic patient records were examined. Glycaemic control was shown to have clinically improved over time, with only 10.8% of patients having poor control at their latest HbA1c test. Despite improvement in HbA1c, only 35.4% of patients had been referred for diabetes education to a diabetes clinic. eGFR showed an overall decline in patient kidney function above the level of decline consistent with aging. Males were significantly more likely to have microalbuminuria with increased severity than females. The study demonstrated an overall clinical improvement in the diabetic control of patients, while identifying key at risk sub-populations. The findings suggest the need for continuous patient orientated management, while highlighting areas for improvement that impact patient health outcomes and avenues for service sustainability greater.