title: Trends in the prevalence and management of diagnosed type 2 diabetes 1994-2001 in England and Wales.
abstract: BACKGROUND
  Type 2 diabetes is an important cause of morbidity and mortality. Its prevalence appears to be increasing. Guidelines exist regarding its management. Recommendations regarding drug therapy have changed. Little is known about the influence of these guidelines and changed recommendations on the actual management of patients with type 2 diabetes. This study aims to document trends in the prevalence, drug treatment and recording of measures related to the management of type 2 diabetes; and to assess whether recommended targets can be met.
  
  
  METHODS
  The population comprised subjects registered between 1994 and 2001 with 74 general practices in England and Wales which routinely contribute to the Doctors' Independent Network database. Approximately 500,000 patients and 10,000 type 2 diabetics were registered in each year.
  
  
  RESULTS
  Type 2 diabetes prevalence rose from 17/1000 in 1994 to 25/1000 in 2001. Drug therapy has changed: use of long acting sulphonylureas is falling while that of short acting sulphonylureas, metformin and newer therapies including glitazones is increasing. Electronic recording of HbA1c, blood pressure, cholesterol and weight have risen steadily, and improvements in control of blood pressure and cholesterol levels have occurred. However, glycaemic control has not improved, and obesity has increased. The percentage with a BMI under 25 kg/m2 fell from 27.0% in 1994 to 19.4% in 2001 (p < 0.001).
  
  
  CONCLUSIONS
  Prevalence of type 2 diabetes is increasing. Its primary care management has changed in accordance with best evidence. Monitoring has improved, but further improvement is possible. Despite this, glycaemic control has not improved, while the prevalence of obesity in the diabetic population is rising.
authors.affiliation: Department of Community Health Sciences, St George's Hospital Medical School, London SW17 0RE, UK. slusigna@sghms.ac.uk
authors.forename: Simon
authors.initials: S
authors.lastname: Lusignan
authors.forename: Charalambos
authors.initials: C
authors.lastname: Sismanidis
authors.forename: Iain M
authors.initials: IM
authors.lastname: Carey
authors.forename: Stephen
authors.initials: S
authors.lastname: DeWilde
authors.forename: Nicky
authors.initials: N
authors.lastname: Richards
authors.forename: Derek G
authors.initials: DG
authors.lastname: Cook
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D002784:Cholesterol / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology*; D016903:Drug Monitoring; D004739:England / Q000453:epidemiology; D005194:Family Practice / Q000379:methods / Q000592:standards / Q000639:trends*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis / Q000187:drug effects; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000145:classification / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008501:Medical Records, Problem-Oriented; D008687:Metformin / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012042:Registries; D012307:Risk Factors; D045162:Thiazolidinediones / Q000008:administration & dosage / Q000627:therapeutic use; D014852:Wales / Q000453:epidemiology
chemical_list: D002784:Cholesterol; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008687:Metformin; D045162:Thiazolidinediones