Management of hypertension and screening of renal complications by GPs in diabetic type 2 patients (France--2001).
BACKGROUND
Our aim was to assess the quality of the medical management by GPs of hypertension and renal insufficiency in type 2 diabetic patients.


METHODS
A retrospective cohort study was run on a national random representative sample of 5,518 patients presenting with type 2 diabetes mellitus treated pharmacologically by a general practitioner from April 2000 to April 2001.


RESULTS
Sixty percent of patients underwent a HbA(1c) measurement during the last 6 months and among them 27% exceeded the threshold of 8%. Glomerular Filtration Rate, calculated with the Cockcroft formula, was below 60 ml/min (confirmed renal failure) in 21.9% of patients and was in the 61-80 ml/min range (probable early renal insufficiency) in 27%. Proteinuria was documented in 30.1% of patients, 13.7% of whom were positive. Microalbuminuria was documented in 36%, 15% of whom were positive. Hypertension was treated pharmacologically in 59.6% of the sample (39.3% on monotherapy, 34.2% on double combination therapy and 26.5% on triple combination therapy or more). Blood pressure was >140 and/or 80 mmHg in 81.6% of treated patients and in 27% among untreated.


CONCLUSIONS
These findings suggest that significant progress still needs to be made in the care and treatment of type 2 diabetic patients, especially those with hypertension, in order to reduce or delay the incidence of renal and cardiovascular complications.
Fagnani
F
F
Cemka, Bourg-la-Reine, France. francis.fagnani@cemka.fr
Souchet
T
T
Labed
D
D
Gaugris
S
S
Hannedouche
T
T
Grimaldi
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000145:classification / Q000627:therapeutic use; D001794:Blood Pressure; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D005194:Family Practice; D005260:Female; D005602:France / Q000453:epidemiology; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D018579:Patient Selection; D015995:Prevalence; D012189:Retrospective Studies
D000959:Antihypertensive Agents; D006442:Glycated Hemoglobin