Screening of long-term complications and glycaemic control of patients with diabetes attending Rustenburg Provincial Hospital in North West Province, South Africa

BACKGROUND: The prevalence of diabetes mellitus (DM) is increasing worldwide, with more than 90% being type 2. In South Africa, DM is common amongst all racial groups with the highest prevalence amongst the Indian population (15.8%), followed by the White (3.5%) and Black (4.8%) populations. Long-term cardiovascular, renal, neurovascular and retinal complications of type 2 DM are major causes of disability and mortality - hence the need for screening. OBJECTIVE: To describe the screening practices of long-term complications amongst patients with type 2 diabetes attending Rustenburg Provincial Hospital in North West Province (South Africa). METHOD: A cross-sectional quantitative study using patients’ clinical records was performed. A random sample of 92 out of 1340 patients with type 2 diabetes attending the hospital in 2007 was selected. Demographic information on age, gender, body mass index, residence, level of education, duration of treatment and type of treatment was obtained. The recorded glycosylated haemoglobin (HbA(1)c), lipids and blood pressure levels were extracted, as well as the results of the dilated eye exam, foot examination, urine test for microalbumin, blood urea and creatinine. The data was analysed using the EPI Info version 6.05 software package. RESULTS: The screening tests that were carried out consistently included: glycosylated haemoglobin (95.7%), blood pressure (100%), serum glucose (100%), serum cholesterol (79.3%) and serum creatinine (93.5%). Aspects poorly screened for were: dilated eye examination (19.5%), foot examination (20.6%), urine test for micro-albumin (1.1%), as well as HDL and LDL cholesterol (17.4%). Abnormal results were mainly detected in: HbA(1)c (69.3%), serum creatinine (30.2%), dilated eye examination (38.9%) and foot examination (52.6%). The HbA(1)c of 9.1% is far above the target of 6% and this predisposes patients to long-term complications. CONCLUSION: The screening of long-term complications of type 2 DM was poor in most patients and demonstrated a high prevalence of abnormal results. There is a need to improve screening practices.