Management of type 2 diabetes with multiple oral hypoglycaemic agents or insulin in primary care: Retrospective cohort study
Calvert MJ., McManus RJ., Freemantle N.
Background: Intensive glycaemic control can reduce the risk of microvescular 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-UNK 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 A1c(HbA1c) assessments 6 months before and following initiation of their last oral therapy. Mean HbA1cbefore 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 HbA1cassessments, 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 HbA1cassessments 6 months before and following insulin. Mean HbA1cbefore 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 HbA1c≥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. © British Journal of General Practice 2007.