Abstracts / Posters
How well are we achieving National Institute for Clinical Excellence (NICE) clinical targets for diabetes?
Accepted by CVD Prevention VI, London, March 2003, but invited instead to do oral presentation on overall audit and intervention outcomes.
The Counterweight Project Team
Introduction: Coronary heart disease (CHD) is the most common cause of death in people with type 2 diabetes. Appropriate management of blood glucose, blood pressure and lipids can limit and prevent CHD. NICE have recently published guidelines on the management of type 2 diabetes recommending at least annual weight, blood pressure (target <140/80mmhg)|, HbA1c (target <7.5%) and lipids (target cholesterol <5mmol/L or LDL <3 mmol/L , triglycerides<2.3mmol/L) measurements. Those with initial blood pressure >140/80mmhg, should have 2 repeat measures in 2 months, with 3 consecutive high readings indicating a diagnosis of hypertension.
Aim: This study examines the proportion of patients in primary care with type 2 diabetes whose care meets these targets.
Methods: Medical records were reviewed for 100 randomly selected obese patients (BMI> 30) from 40 practices (n=4000) in the Counterweight programme (UK, 7-centre obesity initiative). All recorded weight, blood pressure, HbA1c and lipid results for the preceding 12 months were collected. Recorded diagnoses of hypertension and dyslipidaemia were noted along with documentation of practice-based diet counselling or dietetic referral.
Results: 386 obese patients had type 2 diabetes (9.7%). Recordings of weight (77%), blood pressure (82%), HbA1c (71%), and lipids (61%) were present in the ultimate 12 months. Of these, no blood pressure (3%), HbA1c (21%) or lipid measurements (25%), were present anywhere in the primary care records. 57% of those with a HbA1c value had a result >7.5%. Of those with > 1 blood pressure measurement (n=315), 214(68%) had a blood pressure >140/80mmhg on at least one occasion. 34 of 214 patients (16%) had 2 repeat measures within 2 months and 32 of 315 (10%) where found to have 3 readings >140/80mmhg in 2 months. 50% of the 386 type 2 diabetics were coded as hypertensive in the medical notes. Of those with >1 lipid measurement, 25% had triglycerides>2.3mmol/L, 57% had total cholesterol >5 mmol/L and/or LDL>3 mmol/L, a total of 61% being dyslipidaemic. 25% of patients with type 2 diabetes were coded as having dyslipidaemia in the medical notes. Over the 12 month period 38% of patients with type 2 diabetes were documented as receiving diet counselling, and 10% were referred to a dietitian.
Conclusion: Monitoring and achievement of clinical targets for blood pressure, lipids and glucose control in obese patients with type 2 diabetes is below current standards set in England and Wales. There is considerable room for improvement in the management of diabetes in order to reduce CHD risk and mortality.