AUDIT OF PUBLIC-SECTOR PRIMARY DIABETES CARE IN CAPE-TOWN, SOUTH-AFRICA - HIGH PREVALENCE OF COMPLICATIONS, UNCONTROLLED HYPERGLYCEMIA, ANDHYPERTENSION

This study was undertaken to investigate the prevalence of diabetes co mplications and level of glycaemic and blood pressure control in Black African patients at the primary care level in the public sector Cape Town, South Africa. A stratified random sample of 300 patients attendi ng the three largest ambulatory diabetes clinics in community health c entres in Black African residential areas of Cape Town (100 patients f rom each) during the last 6 months of 1992 was selected. Each patient had a clinical examination, interview, and 1 year retrospective record review. Eighty-one per cent of the sampled patients were reviewed, 90 % were non-insulin-dependent (NIDDM) and 10 % were treated with insul in. The mean duration of diabetes was 8 (range 0-28) years. Acceptable glycaemic control was present in 49.4 % (95 % Confidence Intervals 45 .6-53.5) of patients while 38.5 % (CI 24.8-52.2) of hypertensive patie nts had acceptable blood pressure control. The prevalence of any grade of retinopathy was 55.4 % (CI 48.90-62.9), proliferative and preproli ferative retinopathy 15.6 % (CI 8.5-22.8), cataracts 7.9 % (CI 4.4-11. 4), peripheral neuropathy 27.6 % (CI 15.2-39.4), absent foot pulses 8. 2 % (CI 5.2-12.6), amputations 1.4 % (CI 0.4-2.4), persistent proteinu ria 5.3 % (CI 2.5-8.1) and an elevated albumin-creatinine ratio 36.7 % (CI 29.0-44.4). The complications were not documented in the clinic r ecords of the preceding year with the exception of 1 patient with abse nt foot pulses and the 12 patients with proteinuria. The high prevalen ce of suboptimal glycaemic and blood pressure control as well as compl ications of diabetes, largely unrecorded in the preceding years' clini c notes, demonstrates the deficiency of and need for preventative diab etes care at the primary care level. The design, institution, and eval uation of effective intervention programmes are a priority to improve the quality of care provided and the health of diabetic patients. (C) 1997 by John Wiley & Sons, Ltd.