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.