Suboptimal control and failure to intensify therapy for South Africans with type 2 diabetes: an audit of diabetes management at primary health care facilities

Figures & data

Table 1: Demographics and clinical characteristics of a population of patients with type 2 diabetes in the Tshwane district (N = 479), February to May 2019

Patient characteristics	n (%)
Gender
Women	305 (64.0)
Men	174 (36.0)
Age (years)
Mean (SD)	58.0 (11.8)
28–50	127 (27.0)
51–65	221 (46.0)
> 65	129 (27.0)
Ethnicity
African	419 (89.0)
Other*	54 (11.0)
Duration of diabetes (years)
Median (IQR)	5.5 (3.0–9.0)
HbA1c categories
≤ 8%	167 (48.0)
8–10%	92 (27.0)
> 10%	87 (25.0)
Current glucose-lowering treatment
Step 1: metformin only	153 (32.0)
Step 2: SU with/without metformin	219 (46.0)
Step 3: Insulin with/without metformin/SU	107 (22.0)
Statins	375 (78.0)
Hypertension	397 (83.0)

Other = White, Coloured, and Asian/Indian; SU = sulphonylureas.

Table 2: Diabetes control parameters and proportion that reached the SEMDSA targets in a population of patients with type 2 diabetes in the Tshwane district (N = 479)

Diabetes control parameters	Tests done, n (%)	Proportion reaching target (%)	95% CI (%)	Mean (SD)	Range (Min.–Max.)
HbA1c (%)	346 (72)	23	18.9–27.9	8.8 (2.4)	2.7–18.9
Lipids (mmol/L)
LDL cholesterol	88 (18)	15	8.1–23.9	2.7 (1.0)	0.7–6.5
Total cholesterol	333 (70)	59	53.7–64.5	4.3 (1.0)	1.31–10.3
Blood pressure BP (mmHG)
Systolic	476 (99)	65	60.4–69.2	134.4 (18.2)	74–197
Diastolic	476 (99)	85	81.6–88.2	79.5 (11.1)	31–124
Combined	–	56	51.5–60.6

A greater proportion of people with T2D on insulin (86%, n = 76) and on sulphonylureas (83%, n = 129) did not meet the SEMDSA target for glycaemic control compared with the proportion of people on metformin only (60%, n = 61) (p < 0.001).

Table 3: Treatment adjustment and change in HbA1c in suboptimally controlled patients on oral glucose-lowering therapy with two consecutive HbA1c

Factor	Second HbA1c < 7% (n = 7)	Second HbA1c ≥ 7.1% (n = 46)	p-value
Treatment adjustment, n (%)
Intensified	0	10 (100.0)	0.171
Failed to intensify	7 (16.3)	36 (83.7)
HbA1c change, n (%)
Decreased	7 (20.0)	28 (80.0)	0.126
Increased	0	16 (100.0)
Stable	0	2 (100.0)
Doses, n (%)
On maximum	0	22 (100.0)	0.017
Not on maximum	7 (22.6)	24 (77.4)