Trends in the prevalence and management of diagnosed type 2 diabetes 1994-2001 in England and Wales.
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.
Lusignan
Simon
S
Department of Community Health Sciences, St George's Hospital Medical School, London SW17 0RE, UK. slusigna@sghms.ac.uk
Sismanidis
Charalambos
C
Carey
Iain M
IM
DeWilde
Stephen
S
Richards
Nicky
N
Cook
Derek G
DG
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
D002784:Cholesterol; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008687:Metformin; D045162:Thiazolidinediones