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Diabetes guidelines: easier to preach than to practise?
Author(s) -
Bryant,* Wendy,
Greenfield,* Jerry R,
Chisholm Donald J,
Campbell Lesley V
Publication year - 2006
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2006.tb00583.x
Subject(s) - medicine , diabetes mellitus , type 2 diabetes , blood pressure , outpatient clinic , population , diabetic retinopathy , lipid profile , surgery , endocrinology , environmental health
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.