Management of patients with type 2 diabetes mellitus at a district hospital in Gauteng

Abstract

Background: Diabetes mellitus (DM) is a major health concern in South Africa and worldwide. Type 2 diabetes mellitus (T2DM) is the most prevalent type of diabetes in sub-Saharan Africa. The management of patients with chronic conditions are guided by the Standard Treatment Guidelines (STGs) of South Africa. This study aimed to investigate whether there was compliance to the STGs by health care professionals, in the management of patients with T2DM attending a district hospital in Gauteng and to determine the extent of glycaemic control for these patients. Methods: A retrospective review of 153 medical records of patients with T2DM was conducted. Records from the outpatient department (OPD) were randomly selected by systematic sampling. Patients with T2DM who accessed care between June 2022 and May 2023 were included. Demographic and clinical data was recorded. Results: During the one-year period under study, glycated haemoglobin (HbA1c) was measured once in 69.3% of the patients. Of these patients, only 16% achieved glycaemic targets. Random blood glucose levels and hypertension were checked at each clinic visit. Serum creatinine and serum potassium were done on 79.1% and 79.7% of patients respectively. Eye and foot examinations were performed on 15% and 8.5% of patients, respectively. Exclusive oral hypoglycaemic treatment and exclusive insulin therapy was prescribed in 57.5% and 5.9% of patients respectively. Metformin was the most prescribed oral medication, 93.5% of patients were prescribed metformin as monotherapy or combination therapy with another oral agent with or without insulin. Conclusion: The study demonstrates poor compliance to treatment guidelines. This highlights the need to review the implementation of the treatment guidelines in public sector facilities in South Africa.