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Diabetes guidelines: easier to preach than to practise?

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.

Type Journal
ISBN 0025-729X (Print)
Authors Bryant, W.;Greenfield, J. R.;Chisholm, D. J.;Campbell, L. V. :
Garvan Authors A/Prof Jerry Greenfield
Publisher Name MEDICAL JOURNAL OF AUSTRALIA
Published Date 2006-01-01 00:00:00
Published Volume 185
Published Issue 6
Published Pages 305-9
URL http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16999670
Status Published In-print
OpenAccess Link https://publications.gimr.garvan.org.au/download.php?2028_10547/06 bryant MJA 11165_fm.pdf