The SA Journal Diabetes & Vascular Disease Vol 12 No 2 (December 2015)

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SA JOURNAL OF DIABETES & VASCULAR DISEASE REVIEW
VOLUME 12 NUMBER 2 • NOVEMBER 2015 71
units. Patients selected for the studies included in the review were
treated to ‘moving targets’ and therefore studies conducted in the
past five years only (2009–2014) were included, as recent guidelines
have more similar targets.
Some eight out of the 14 studies provided information on the type
of methods used for clinical and laboratory-based measurements,
but with differing levels of detail. Notably, only two studies confirmed
use of DCCT-standardised laboratory analysers for HbA1c analysis.
By converting to similar units (e.g. LDL-C from mg/dl to mmol/l),
target values in this retrospective study (Table 1) were presented
in a format that would allow for comparison. Ideally, a centralised
laboratory should have been used for measurements included in
this study, however, we relied on previously obtained measurements
from other studies. We therefore cannot guarantee the accuracy or
precision of measurements in the studies selected for this review,
as methodologies may have differed. Studies from resourcerich
settings may have implemented newer, more sophisticated and
improved methods for A1c and LDL-C measurements, influencing
the results of those specific studies.
This review did not stratify the selected individual studies according
topatient profiles, severity of disease, clinical settings (clinic or hospital)
or involvement of specialists (factors affecting how individuals are
managed and able to reach guideline targets). Although smoking is
considered a critical risk factor in the prevention and management of
CVD, it was not included as a crucial study parameter for this review
(partly due to many studies not reporting this).
Although previously identified as a source of bias, we only
included studies published in English, which according to an
analysis, has little effect on summaries of treatment effect
estimates.28 Publication bias may have occurred in our study in that
a single reviewer (author) carried out the searches without the use
of specific methodology (e.g. Cochrane data system).
Conclusion
The results presented in this study demonstrate that T2DM patients
remain inadequately controlled for their cardiovascular risk factors.
Our review revealed that control of major risk factors did not
differ significantly between countries or healthcare settings. There
is substantial room for improvement in the way T2DM patients
are being managed for their condition. Further efforts through
multidisciplinary action to improve guideline adherence is critical
for the prevention or delay of diabetesrelated complications.
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