Individualised treatment goals in diabetes care.
OBJECTIVE
To examine 1) patients' characteristics according to the treatment goal chosen at diabetes diagnosis, and 2) the association between individualised goals for glycated haemoglobin (HbA1c), blood pressure (BP) and lipids, and the risk factor level subsequently achieved.


METHODS
Follow-up study embedded in a multifaceted intervention study directed at doctors encouraging individualised goal-setting in newly diagnosed diabetic patients aged > or = 40 years.


METHODS
General practice.


METHODS
In all, 243 general practitioners and 674 patients participated.


METHODS
Risk factors for diabetic complications.


RESULTS
Relatively young age, low diagnostic plasma glucose, low BMI, a moderate or high level of physical activity and normoalbuminuria were associated with a treatment goal of good control at diagnosis. After 5 years, median HbA1c was 8.2%, 8.6% and 8.0% in patients with a goal of good, acceptable and poor control, respectively. Patients with a goal of good control versus those with a goal of acceptable control had a lower HbA1c level in a regression analysis adjusted for age, sex, HbA1c at diagnosis, BMI, total cholesterol, fasting triglycerides, BP, physical activity, smoking status and diabetes duration. We found no association between goals and the level of BP and lipids.


CONCLUSIONS
Doctors tend to pursue normoglycaemia in relatively young patients with low blood glucose, low BMI, high activity level and normoalbuminuria. Patients for whom a goal of normoglycaemia was chosen at diagnosis achieved favourable glycaemic control at 5-year follow-up. Whether doctors choosing the goals were good at predicting future glycaemic control, or whether goal-setting is an important motivational factor in achieving optimal glycaemic control needs to be explored.
Hansen
Lars J
LJ
Central Research Unit and Department of General Practice, University of Copenhagen, Copenhagen, Denmark. L.Hansen@gpract.ku.dk
Olivarius
Niels de Fine
Nde F
Siersma
Volkert
V
Drivsholm
Thomas
T
Andersen
John Sahl
JS
D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D003718:Denmark; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D008055:Lipids