Cognitive function and quality of diabetes care in patients with Type-2-diabetes mellitus in general practitioner practice.
OBJECTIVE
The goal of the trial was the assessment of the quality of diabetes control and the cognitive function of all patients with type 2 diabetes mellitus treated in a randomly selected general practitioner practice in Thuringia, Germany. Furthermore possible interactions between patients' quality of diabetes control and their cognitive function should be analysed.


METHODS
The investigation comprised all 141 patients with type 2 diabetes mellitus (age 67.3 +/- 10.5 years, body-mass index 29.3 +/- 4.5 kg/m2, patients without insulin therapy: n = 102, with insulin therapy: n = 39) who were patients at the general practitioner practice in Wandersleben, Thuringia, Germany, between November 1999 and April 2000.


RESULTS
The mean HbA1c of all patients examined was 6.33 +/- 1.1% (normal range 3.5-6.8%). 55 patients were treated with diet (HbA1c 5.7 +/- 0.76%) and 47 patients were given oral antidiabetic drugs (HbA1c 6.5 +/- 0.76 %). 27/47 (57.4%) patients were treated with sulfonylurea, 37/47 (78,7%) with metformin, 3/47 (6,4%) with acarbose and 7/47 (14.9%) patients received glinides. 18/47 (38,3%) patients had combinations out of two or more oral antidiabetic drugs. A total of 39 patients with type 2 diabetes mellitus were treated with insulin (HbA1c 7.0 +/- 1.24%). The premorbide cognitive function of the patients was 97.9 +/- 10.0 IQ-points. It was significantly better than the actual cognitive function (91.8+/-13.5 IQ-points, p<0.001). The actual cognitive function showed a correlation with patient's age (r = -0.28, p = 0.001), educational level (r = -0.25, p = 0.006) and profession (r = -0.29, p = 0.001). Performing multivariate analysis the premorbide cognitive function (b = 0.53, p<0.001) and patient's age (b = -0.32, p<0.001) showed associations with the actual cognitive function (R-square =0.36). Associations with the HbA1c (R-square = 0.37) showed the frequency of blood glucose self monitoring (beta = 0.38, p<0.001), the blood glucose value at the time of examination (beta = 0.34, p<0.001) and the diabetes duration (beta = 0.16, p = 0.03). There were no associations between actual cognitive function and other parameters.


CONCLUSIONS
The data from this trial presents evidence which shows that treatment by general practitioners can enable patients both with and without insulin therapy to achieve a high quality of diabetes control. Hence, the results derived from ambulatory evaluations of treatment programmes can not be automatically tansferred to patients treated at hospitals. Regarding inpatient treatment, adapted structured treatment and teaching programmes are mandatory.
Schiel
Ralf
R
University of Jena Medical School, Department of Internal Medicine III, D-07740 Jena, Germany. ralf.schiel@med.uni-jena.de
Bocklitz
G
G
Braun
A
A
Leppert
K
K
Stein
G
G
Müller
U A
UA
D000368:Aged; D015190:Blood Glucose Self-Monitoring; D003071:Cognition / Q000502:physiology*; D003625:Data Collection; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy*; D004032:Diet; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010821:Physicians, Family / Q000592:standards*; D011787:Quality of Health Care; D012959:Socioeconomic Factors; D016896:Treatment Outcome