Diabetes guidelines: easier to preach than to practise?

Med J Aust. 2006 Sep 18;185(6):305-9.

Abstract

Objective: To review the management of glycaemia, blood pressure and serum lipids in a hospital outpatient diabetes clinic, the director of which co-authored the current national diabetes management guidelines.

Design: Retrospective audit.

Setting: Outpatient diabetes clinic in a tertiary referral teaching hospital, Sydney, NSW.

Study population: 96 patients with type 1 diabetes (mean age, 44.4 [SD, 12.8] years) and 509 patients with type 2 diabetes (mean age, 64.4 [SD, 12.0] years) attending the clinic in 2003, who had undergone formal review of complications.

Main outcome measures: Weight, height, control and treatment of glycaemia, blood pressure and serum lipids, and prevalence of diabetic microvascular complications.

Results: Glycated haemoglobin (HbA(1c)) was < 7% in 13% of type 1 and 30% of type 2 diabetes patients, and > 8% in 47% and 34%, respectively. 35% of patients with type 1 diabetes and 71% of patients with type 2 diabetes were treated with antihypertensive agents. Of these patients, 29% and 24%, respectively, had blood pressure readings </= 130/80 mmHg. Among patients not treated with hypertensive agents, blood pressure readings were </= 130/80 mmHg in 60% of type 1 and 38% of type 2 diabetes patients. About 30% of patients with type 1 diabetes and 50% of those with type 2 diabetes were being treated with lipid-lowering agents; of these, about 60% had low-density lipoprotein (LDL) cholesterol levels < 2.6 mmol/L. Among patients not treated with lipid-lowering agents, about 40% had LDL cholesterol levels < 2.6 mmol/L. Retinopathy was documented in 52% and 18%, and nephropathy in 9% and 36% of type 1 and type 2 diabetes patients, respectively.

Conclusions: Despite the demonstrated benefits of tight glucose, blood pressure and lipid control in reducing the risk of macrovascular and microvascular complications in type 1 and type 2 diabetes, our results suggest that treatment targets are not being met in a large proportion of patients attending a tertiary referral hospital. Responsible practice suggests that treatment targets and the current means to achieve them should both be examined.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Antihypertensive Agents / therapeutic use
  • Blood Glucose / metabolism
  • Diabetes Mellitus, Type 1 / complications*
  • Diabetes Mellitus, Type 1 / epidemiology
  • Diabetes Mellitus, Type 1 / therapy*
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetes Mellitus, Type 2 / therapy*
  • Female
  • Glycated Hemoglobin A / metabolism
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Hypertension / etiology
  • Hypertension / prevention & control
  • Male
  • Medical Audit*
  • Middle Aged
  • Myocardial Infarction / etiology
  • Myocardial Infarction / prevention & control
  • New South Wales / epidemiology
  • Outpatient Clinics, Hospital
  • Peripheral Vascular Diseases / etiology
  • Peripheral Vascular Diseases / prevention & control
  • Practice Guidelines as Topic
  • Quality Assurance, Health Care
  • Retrospective Studies

Substances

  • Antihypertensive Agents
  • Blood Glucose
  • Glycated Hemoglobin A