A recent study was conducted

A recent study was conducted in Saudi Arabia in which only 27% of the study patients reached the target HBA1C of <7%, 16% attained the target blood pressure of <130/80 and 65% had a lipid profile above the optimal level (Al-Elq, 2009). Another study in primary care clinics showed similar results as only 24% of the patients achieved a HBA1C level of <7% (AlFadda and Bin Abdulrahman, 2006). Therefore, the current study was conducted to evaluate glycemic control of diabetic patients at the King Khalid University Hospital (KKUH) in Riyadh, Saudi Arabia. KKUH is a general hospital with an open access for all Saudis as well as non-Saudis King Saud University employers.
Methods
A cross sectional study was conducted among diabetic patients attending the King Khalid University Hospital, Riyadh. Patients were identified through the hospital pharmacy records of prescription of CM-272 and oral hypoglycemic agents (OHA) over a one year period (January–December, 2009) whether they are followed up in primary health care clinics (PHCC) or specialty clinics. Criteria for inclusion were adult patients >18years of age of both sexes, both Saudi and non-Saudi, on diabetic treatment. A total of 20,000 patients were identified, and 1520 patients were selected by simple random method.
The goals for adequate glycemic control in this study were specified by 2009 American Diabetes Association (ADA) guidelines as follows: HbA1C<7%, low density lipoprotein (LDL) <2.6mmol/L, high density lipoprotein (HDL) >1mmol/L, triglyceride <1.7mmol/L, systolic blood pressure <130mmHg, diastolic blood pressure <80mmHg, fasting blood sugar (FBS) 3.9–7.2mmol/L and postprandial blood sugar <10mmol/L. Data were entered in a computer, and analyzed using the SPSS program and were presented as percentages. The chi square test was used for evaluating the relationship between variables; a p value less than 0.05 was considered significant.
Results
Characteristics of the diabetic patients are shown in Table 1. About 90% of patients were older than 40years old and 90% were overweight or obese. Most patients were followed in primary care clinics (93%). Although 1520 medical charts were reviewed, some data were missing; for example BMI was available for only 1377 patients.
Fasting blood sugar was more than 7.2mmol/L in 60% of patients and about 70% had random blood sugar more than 10mmol/L. The overall glycemic control was evaluated through measurement of HBA1C, which was acceptable in about 40% of the patients, and the cholesterol level was normal in more than 70% of patients while triglyceride was normal in only 56% of patients. About half of the patient’s systolic blood pressure was not controlled, while in 27% of patients the diastolic blood pressure was above the target level (Table 2).
When the relationship between socio-demographic characteristics and HBA1C was analyzed, there was a significant relationship between HBA1C and sex, nationally, and age in which male, Saudi nationals, and older patients were better controlled than others Table 3.

Discussion
The adequacy of glycemic control in diabetes mellitus is a cornerstone in reducing morbidity and mortality of the disease (ADA, 2009; Beaton et al., 2004; Charpentier et al., 2003). More than half of the patients in the present study were not adequately controlled and this represents a serious problem because diabetes is a very prevalent disease (23.7%) in the Saudi community (Al-Nozha et al., 2004). This poor control of the disease, will no doubt result in an increasing prevalence of diabetic complications and high morbidity and mortality. Although the University Hospital offers a high standard of medical care, the findings of the present study show that diabetic control is suboptimal. Many factors may account for this, the first and foremost is poor patient compliance with treatment. In addition, others factors are lifestyle modifications and long wait times in the hospital appointment system, because the hospital does not have a well defined population and it offers medical care to all Saudis. Knowledge and application of published guidelines of diabetes management may not be optimal, which may also explain the poor control. Many earlier studies have reported similar findings (Beaton et al., 2004; Harris, 2000; Saydah and Fradkin, 2004)