title: Diabetes care and complications in primary care in the Tshwane district of South Africa.
abstract: OBJECTIVE
  To describe the diabetic population receiving primary care from the Tshwane district public health services and to assess the quality of care of members of this population, their level of disease control and the extent of their complications.
  
  
  METHODS
  A cluster-randomised trial was conducted in 12 primary care clinics in Tshwane district. A total of 599 diabetic patients attending these clinics for review were consecutively interviewed and clinically examined. Data on the care received was also obtained from their clinical records for the previous 12 months. Patients randomised to the active arm of the study were screened for complications.
  
  
  RESULTS
  The mean age was 58 years and 80.5% had a body mass index (BMI) ≥25 kg/m(2). Sixty-eight percent of patients were female. Acceptable glycaemic control and LDL-cholesterol were found for only 27% and 33% of patients, respectively (HbA1c<7%; LDL<2.5 mmol/l). Despite more than 79% of patients reporting to be hypertensive, 68% of patients had a systolic blood pressure above 130 mmHg and 64% had a diastolic blood pressure above 80 mmHg. Evaluating patient records of the preceding year, screening for eye complications was only reported in 8.2%, feet complications in 6.5%, kidney complications in 21.4% and cardiovascular complications in 7.8%. The screening prevalences found were 29% for retinopathy, 22% for maculopathy, 5% for neuropathy (neurothesiometer), 7% for nephropathy (eGFR stages 3-5), 17% for possible infarction (Rose questionnaire) and 36% for severe erectile dysfunction (SHIM questionnaire).
  
  
  CONCLUSIONS
  Diabetes care and screening for complications at primary care level in the Tshwane district were found to be sub-optimal. Measures should be taken to address this.
authors.affiliation: School of Health Systems and Public Health, University of Pretoria, South Africa. Electronic address: elize.webb@up.ac.za.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Webb
authors.affiliation: School of Health Systems and Public Health, University of Pretoria, South Africa.
authors.forename: Paul
authors.initials: P
authors.lastname: Rheeder
authors.affiliation: Department of Internal Medicine, Kalafong Hospital, University of Pretoria, South Africa.
authors.forename: Danie G
authors.initials: DG
authors.lastname: Van Zyl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D001794:Blood Pressure; D015992:Body Mass Index; D008078:Cholesterol, LDL / Q000097:blood; D048909:Diabetes Complications / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D019983:Guideline Adherence / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011237:Predictive Value of Tests; D015995:Prevalence; D011320:Primary Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Complications screening; Diabetes; Metabolic control; Primary care