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Improving glycaemic control in patients with Type 2 diabetes mellitus without insulin therapy
Author(s) -
Goudswaard A. N.,
Stolk R. P.,
De Valk H. W.,
Rutten G. E. H. M.
Publication year - 2003
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1046/j.1464-5491.2003.00980.x
Subject(s) - medicine , diabetes mellitus , type 2 diabetes mellitus , insulin , attendance , endocrinology , economics , economic growth
Aims In general practice at least 30% of those with Type 2 diabetes do not achieve good glycaemic control. We studied the effect of improving oral glucose‐lowering medication in a primary care setting in patients treated with oral hypoglycaemic agents without satisfactory glycaemic control. Methods We provided flowcharts to general practitioners and outreach visits by trained facilitators, who checked adherence to the protocol. Fifty‐two Dutch general practices with 2140 Type 2 diabetes mellitus (DM) patients recruited 288 patients ≤ 75 years old inadequately controlled (HbA 1c > 7%) by diet or oral medication. Outcome measures were decrease of HbA 1c , number of patients with HbA 1c ≤ 7%, and non‐compliance rate. Results After a mean of 3.3 consultations over 14 weeks, 209 patients were following the protocol fully with a reduction in HbA 1c from 8.7% to 6.7% ( P < 0.001). One hundred and fifty‐eight patients (55%) achieved HbA 1c ≤ 7%, and 51 (18%) persisted with HbA 1c > 7% unless fasting blood glucose ≤ 7 mmol/l ( n = 18) or a maximum of medication ( n = 33). Seventy‐nine patients (27%) did not adhere to the protocol, mostly due to loss of motivation and non‐attendance. Conclusions A simple flowchart and relatively little support by trained facilitators results in improved glycaemic control. Diabet. Med. 20, 540–544 (2003)