Prevalence, Patient Predictors, and Referral Patterns for Diabetes-Related Complications Treated at a Central Hospital in KwaZulu Natal

PURPOSE: Poor diabetes control can result in short- and long-term neuropathic, microvascular, and macrovascular complications. In addition to the socioeconomic impact that diabetes and its complications has on patients, incremental financial costs are added to health-care systems. This study aimed to assess prevalence, patient-related factors, and referral patterns for patients with diabetes-related complications managed at Inkosi Albert Luthuli Central Hospital (IALCH) betweenJanuary 1, 2014 and December 31, 2015. METHODS: The retrospective cross-sectional study was done on all adult patients (aged >18 years) with diabetes consulted at IALCH. Primary outcome measures were the proportion with diabetes-related complications and the source of referrals. Logistic regression analysis was done to identify predictors of diabetes complications. RESULTS: Of all adult diabetes patients consulted, 7,761 (47.4%) presented with one or more diabetes-related complications and 56% (4,321) had experienced macrovascular complications. Cardiovascular complications (2,576, 33%) were the most common complications, followed by peripheral vascular disease (1,755, 23%). Microvascular complications included retinopathy (1,656, 21%), nephropathy (118, 14%), and neuropathy (702, 9%). After multivariate analysis, all four factors (age >58 years, male sex, Indian ancestry, and non–insulin dependent diabetes mellitus remained statistically significant for an increased likelihood of developing cardiovascular complications. Indian ancestry was not associated with increased odds of peripheral vascular disease. CONCLUSION: Macrovascular diseases were the main complications. Older age, male sex, Indian ancestry, and non–insulin dependent diabetes mellitus were associated with macrovascular complications. A combination of health-promotion and behaviour-modification programs is required prior to or early in the disease course. Appropriate and more aggressive management at primary-care level using evidence-based clinical guidelines is essential to prevent complications.