Original researchExploring reasons for very poor glycaemic control in patients with Type 2 diabetes
Introduction
Improving glycaemic control in people with Type 2 diabetes reduces the risk of diabetic microvascular complications [1]. Whilst there is some debate over target levels of glycaemia, particular in people with long duration of diabetes and clinical or subclinical cardiovascular disease [2], [3], there is evidence that extremely poor glycaemic control (glycated haemoglobin [HbA1c] above 10% [86 mmol/mol]) is undesirable and likely to have an adverse impact on health and outcomes.
Improving glycaemic control can be challenging, particularly in ethnically diverse and deprived populations. Whilst therapeutic advances in glycaemic management have become available, and significant improvements in primary care management of diabetes have occurred over the last few years [4], there remains a significant cohort of patients with Type 2 diabetes who have extremely poor glycaemic control.
The aim of this study was to determine prevalence of very poor glycaemic control amongst a population of patients with Type 2 diabetes in an ethnically diverse and deprived population, to explore some of the reasons why glycaemic control is poor in such patients, and to determine whether a patient centred care planning approach could improve glycaemic control in such patients [5].
Section snippets
Methods
The study was undertaken as part of routine review of diabetic patients in three health centres North East London. Routine diabetes care was undertaken in all of these practices, with specialist support in the form of visiting diabetes nurse specialists and consultant in diabetes. Complex patients with significant co-morbidities are referred to a specialist diabetes clinic in the local hospital.
The practice database of three large primary care health centres (total population 28,677) were
Results
The total practice population was 28,677 patients, of whom 1261 patients had Type 2 diabetes for greater than one years duration (4.4%). Of these, 143 (11.3%) had their last recorded glycated haemoglobin 10% (86 mmol/mol) or greater. Demographic details of these patients are shown in Table 1. Compared to patients who had HbA1c < 10% (86 mmol/mol), the poorer control group had significantly longer duration of diabetes, greater proportion of South Asians, and greater proportion of non-insulin
Discussion
Microvascular complications can be significantly impeded by tight glycaemic control in patients with Type 2 diabetes [1]. Recent studies suggest that tight glycaemic control may be important early in the condition to prevent cardiovascular disease, but that tight glycaemic control later in the condition, perhaps when clinical or subclinical cardiovascular disease is present, may lead to adverse outcomes [3]. Nevertheless, extremely poor glycaemic control (HbA1c ≥ 10% [86 mmol/mol]) is likely to be
Conflict of interest
The authors state that they have no conflict of interest.
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