Compliance with diabetes guidelines at a regional hospital in KwaZulu-Natal, South Africa

Background Diabetes is a major problem in South Africa and throughout the world. The management of type 2 diabetes aims at maintaining normoglycaemia and preventing the development of complications arising from diabetes. The Society for Endocrine Metabolism and Diabetes of South Africa (SEMDSA) guidelines are based on a number of international trials which showed that strict control of blood sugar leads to a reduction in the development of diabetic complications. However, many studies have shown poor adherence to national guidelines by doctors caring for diabetes patients. Objectives The aim of this study was to assess doctors’ compliance with the SEMDSA diabetes guidelines at a regional hospital in KwaZulu-Natal. Method Seven hundred and fifty diabetic patient records were selected by systematic sampling of cases from the diabetic clinic and reviewed against SEMDSA guidelines. Results Eighty three per cent of the patients had high values of glycated haemoglobin (HbA 1c ). Lipid examination was rarely performed, and comprehensive foot examination was carried out in only 6% of patients. Although blood pressure and weight were regularly checked, these examinations were performed by the nursing staff, and medical staff generally did not respond to abnormal results. Conclusion This study demonstrates poor compliance with current diabetic guidelines. There is an urgent need to review how guidelines are disseminated and implemented in South African public sector hospitals if evidence-based guidelines are to have any impact on patient care.