[Improvement of glycemic regulation without exogenous insulin in 40% of poorly regulated patients with type 2 diabetes mellitus; a study in 18 family practices].
OBJECTIVE
To determine the possibility of improving glycaemic control in poorly regulated patients with type 2 diabetes mellitus (DM 2) through maximization of oral medication by the general practitioner followed by education and instruction in self-regulation by the diabetes nurse, as required.


METHODS
Explorative, descriptive, prospective cohort study.


METHODS
24 general practitioners selected all known patients with DM 2 and poor glycaemic control (HbA1c value > or = 8% and/or fasting blood glucose > 8 mmol/l), and maximized oral blood glucose lowering drugs if possible. When the HbA1c level remained > or = 8%, patients were referred to the diabetes nurse.


RESULTS
In a population of 735 patients with DM 2 treated by the general practitioner, 146 patients were poorly regulated. Out of 112 patients with sub-maximal therapy, 50 achieved an HbA1c < 8% after adjustment of oral therapy. Of the 60 poorly regulated patients on maximum therapy, 39 were referred to the diabetes nurse. Nine of these patients subsequently achieved an HbA1c level < 8%.


CONCLUSIONS
In 40% (50 + 9/146) of the poorly regulated patients with DM 2, improvement of glycaemic control could be achieved through optimization of oral therapy by the general practitioner and diabetes nurse, without exogen administered insulin.
Berghout
L M
LM
Universitair Medisch Centrum (UMC), Julius Centrum voor Huisartsgeneeskunde en Patiëntgebonden Onderzoek, Utrecht. berghoutlm@planet.nl
Gorter
K J
KJ
Rutten
G E
GE
D000284:Administration, Oral; D000368:Aged; D003663:Decision Trees; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000628:therapy; D004305:Dose-Response Relationship, Drug; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D009426:Netherlands; D010353:Patient Education as Topic / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents