Calvert, MJ; McManus, RJ; Freemantle, N; (2007) Management of type 2 diabetes with multiple oral hypoglycaemic agents or insulin in primary care: retrospective cohort study. BRIT J GEN PRACT , 57 (539) 455 - 460.
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Background Intensive glycaemic control can reduce the risk of microvascular complications in people with type 2 diabetes.Aim To examine the extent of monitoring and glycaemic control of patients with type 2 diabetes prescribed oral agents and/or insulin, and to investigate transition to insulin.Design of study Retrospective cohort study.Setting A total of 154 general practices in the UK contributing to the DIN-LINK database between 1995 and 2005.Method People with type 2 diabetes were identified using Read codes and prescribing data. Outcome measures were: glycaemic monitoring and control on multiple oral agents and/or insulin, and transition to insulin.Results A total of 14 824 people with type 2 diabetes were prescribed multiple oral agents concurrently, of whom 5064 (34.16%) had haemoglobin A(1c) (HbA(1c)) assessments 6 months before and following initiation of their last oral therapy. Mean HbA(1c) before therapy was 9.07%, which dropped to 8.16% following therapy (mean difference 0.91%, 95% confidence interval [CI] 0.86 to 0.95, P < 0.0001). Of the patients with HbA(1c) assessments, 3153 (62.26%) had evidence of poor glycaemic control following therapy. Median time to insulin for patients prescribed multiple oral agents was 7.7 years (95% CI = 7.4 to 8.5 years); 1513 people began insulin during the study and had HbA(1c) assessments 6 months before and following insulin. Mean HbA(1c) before insulin was 9.85% (standard deviation [SD] 1.96%) which decreased by 1.34%, (95% CI = 1.24% to 1.44%) following therapy, but 1110 people (73.36%) still had HbA(1c) >= 2.7.5%.Conclusion Many people with type 2 diabetes received inadequate monitoring and had poor glycaemic control. Intensive management is required to reduce the risk of microvascular complications.
|Title:||Management of type 2 diabetes with multiple oral hypoglycaemic agents or insulin in primary care: retrospective cohort study|
|Keywords:||diabetes mellitus, type 2, drug therapy, primary health care, type 2, INADEQUATE GLYCEMIC CONTROL, RANDOMIZED CONTROLLED-TRIAL, GENERAL-PRACTICE, PREVALENCE, THERAPY, COMPLICATIONS, SULFONYLUREAS, METAANALYSIS, REGRESSION, METFORMIN|
|UCL classification:||UCL > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health Care > Primary Care and Population Health|
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