Patterns of diabetes management in South Africa: baseline and 24-month data from the South African cohort of the DISCOVER study

Objectives: To describe disease management patterns and associated outcomes in patients with type 2 diabetes initiating a second-line glucose-lowering therapy in routine clinical practice in South Africa.Design: Non-interventional observational study.Setting: General and specialist private practices.Subjects Patients with diabetes initiating second-line glucose-lowering therapy.Outcome measures: Variables collected at baseline and at 6-, 12- and 24-month follow-up visits included sociodemographics, first- and second-line glucose-lowering treatments and other medications, reasons for change in diabetes therapy, HbA1c target set by the attending clinician at the time of change, comorbidities and health-related quality of life (HRQoL).Results: Baseline data were collected for 519 patients (69% female). Mean age was 54.6 years and mean time since initial diagnosis was 7.5 years. Mean HbA1c at baseline was 9.0% and the most common second-line treatment approach was to combine metformin with a sulphonylurea. Median HbA1c and median fasting glucose measurements were marginally lower at 24 months than at baseline (8.0% vs. 8.4%, and 8.5 mmol/l vs. 8.8 mmol/l, respectively). Only approximately 5% of patients had had their diabetes medication changed at any time after the baseline visit.Conclusions: Management of type 2 diabetes mellitus in private practice in South Africa is suboptimal.