Display Settings:

Format

Send to:

Choose Destination
See comment in PubMed Commons below
Med J Aust. 2006 Sep 18;185(6):305-9.

Diabetes guidelines: easier to preach than to practise?

Author information

  • 1Diabetes Centre, St Vincent's Hospital, Sydney, NSW, Australia.

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.

Comment in

PMID:
16999670
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Australasian Medical Publishing Company
    Loading ...
    Write to the Help Desk