Diabetes guidelines and clinical practice: is there a gap? The South African cohort of the International Diabetes Management Practices Study

Objectives: The objective of this survey was to determine the therapeutic management of patients with diabetes in the South African private healthcare environment.Design: The International Diabetes Management Practices Study is an international multicentre and observational study. In this paper, the local South African data from the cross-sectional cohort study are discussed.Setting: South African healthcare providers who were involved in the management of patients with diabetes.Subjects: Subjects included male and female adult patients who were diagnosed with type 1 or type 2 diabetes mellitus and who consulted their healthcare provider during a specified period of two weeks.Outcome measures: Information on patient demographic and socio-economic profiles, relevant medical histories, data on previous and concomitant antidiabetic treatments, glycaemic status, patient education levels and the impact of diabetes on absenteeism and hospitalisation was collected.Results: A total of 899 patients from 54 healthcare centres in South Africa participated. The mean age of patients in the study was 53.35 ± 14.47 years. The duration of diabetes was longer in type 1 diabetic patients. Of the type 2 diabetic patients, 46.4% were on oral antidiabetic monotherapy and 44.1% on two oral medications. Metformin was the most commonly prescribed oral medication. Of the 242 patients with type 2 diabetes on insulin and oral combination, 175 were on one oral medication combined with insulin therapy. The mean haemoglobin A1c (HbA1c) of study participants was 8.2%.Conclusion: These data demonstrate that in accordance with current global findings, the glycaemic control of the majority of a cohort of patients with diabetes managed in the private healthcare sector in South Africa was suboptimal when assessed according to HbA1c levels