Understanding blood glucose documentation and monitoring practices in a Western Cape public sector hospital: a retrospective folder review and survey of healthcare professionals

Abstract

According to the International Diabetes Federation (IDF) about 588.7 million people had diabetes mellitus (DM) in 2024 with the prevalence of the disease rising most rapidly over the years in low- and middle-income countries (LMIC) (International Diabetes Federation [IDF], 2025; World Health Organization [WHO], 2024). In 2022, 14.0% of adults older than 18 years had DM globally (WHO, 2024). Remarkably, in the same year 59.0% of adults older than 30 years and diagnosed with DM were not receiving treatment at this time (WHO, 2024). Both the number of individuals with DM and the number of people with untreated DM have been steadily increasing over the past decades (WHO, 2024). Diabetes is, however, not only a global issue but also a prevalent problem in South Africa. In 2024, 2.3 million adults between the ages of 20 and 79 years were living with DM in South Africa (IDF, 2025). Diabetes is a chronic metabolic health condition caused by elevated levels of blood glucose, commonly known as hyperglycaemia (Sifunda et al., 2023). A continuous state of hyperglycaemia increases patients’ risk of vascular and neuronal damage which eventually leads to micro- and macrovascular complications and death. Moreover, when patients with DM are left untreated, or inappropriately treated, the disease can lead to acute life-threatening complications such as hyperosmolar hyperglycaemic syndrome (HHS) and diabetic ketoacidosis (DKA) (Trujilo & Haines, 2023). On the other hand, aggressive glucose control (Lundholm & Morey-Vargas, 2023), over-treatment with anti-hyperglycaemic medication, or a drastic decrease in nutritional intake can then lead to hypoglycaemia, where patients’ blood glucose levels decrease below the normal range, putting them at risk for a hypoglycaemic coma (Trujilo & Haines, 2023).