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Diabetes guidelines: easier to preach than to practise?
Wendy Bryant1, Jerry R Greenfield, Donald J Chisholm
1Diabetes Centre, St Vincent's Hospital, Sydney, NSW, Australia.
The Medical Journal of Australia
|September 27, 2006
Summary
This audit of a diabetes clinic found that treatment targets for blood glucose, blood pressure, and lipids are not being met for many patients with type 1 and type 2 diabetes. Further examination of treatment goals and methods is recommended for better patient outcomes.
Area of Science:
- Endocrinology
- Metabolic Disorders
- Clinical Audit
Background:
- Optimal management of glycaemia, blood pressure, and serum lipids is crucial for reducing diabetes complications.
- National diabetes management guidelines exist, with key contributors involved in this clinic's direction.
Purpose of the Study:
- To review the management of glycaemia, blood pressure, and serum lipids in a hospital outpatient diabetes clinic.
- To assess adherence to national diabetes management guidelines within the clinic setting.
Main Methods:
- A retrospective audit was conducted.
- The study population included 96 patients with type 1 diabetes and 509 patients with type 2 diabetes attending a tertiary referral teaching hospital clinic.
- Data collected included weight, height, glycaemic control, blood pressure, serum lipid levels, and prevalence of microvascular complications.
Main Results:
- Glycated haemoglobin (HbA1c) targets were unmet in a significant proportion of both type 1 (47% > 8%) and type 2 (34% > 8%) diabetes patients.
- Blood pressure and low-density lipoprotein (LDL) cholesterol targets were also frequently not achieved, even among patients on treatment.
- Prevalence of retinopathy and nephropathy was notable in both diabetes types.
Conclusions:
- Despite established benefits, treatment targets for glucose, blood pressure, and lipids are not consistently met in this tertiary hospital clinic.
- The findings suggest a need to re-evaluate current treatment targets and the strategies employed to achieve them.
- Responsible clinical practice necessitates an examination of both treatment goals and the means to attain them for improved diabetes care.
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