Suboptimal glycaemic control in primary care: is the need for intensification of therapy recognised?

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The United Kingdom Prospective Diabetes Study demonstrated the importance of good glycaemic control in patients with type 2 diabetes. Despite this knowledge, half of the population with diabetes have an HbA1c above 8%.Five general practices in Torbay identified all patients with type 2 diabetes and suboptimal glycaemic control (HbA1c >7.5%) who were not on insulin. A retrospective review of the general practice records of patients was performed. Patients were categorised into: need to consider insulin; need to increase oral agents; treatment has recently been appropriately increased; patient plans to commence insulin; insulin considered inappropriate or patient declined insulin; patient under a secondary care diabetes team; patient diagnosed with diabetes within the last year.In all, 376 patients with an HbA1c >7.5% were identified. Of these, 118 patients (31.4%) had appropriately increased their oral medication. Only 21 had discussed insulin initiation but an additional 74 were classified as needing to consider insulin therapy. Twenty-three percent required an increase in their oral hypoglycaemic medication. Insulin was declined by the patient or thought inappropriate in 49 cases. There were 17 new diagnoses and only eight under secondary care.In conclusion, 43% of patients with type 2 diabetes and HbA1c >7.5% required an increase in oral medication or consideration for insulin. This need had not been recognised in the majority of cases. We believe that closer liaison between primary care and specialist diabetes teams is required. Copyright © 2008 John Wiley & Sons.

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