title: Management of type 2 diabetes with multiple oral hypoglycaemic agents or insulin in primary care: retrospective cohort study.
abstract: BACKGROUND
  Intensive glycaemic control can reduce the risk of microvascular complications in people with type 2 diabetes.
  
  
  OBJECTIVE
  To examine the extent of monitoring and glycaemic control of patients with type 2 diabetes prescribed oral agents and/or insulin, and to investigate transition to insulin.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A total of 154 general practices in the UK contributing to the DIN-LINK database between 1995 and 2005.
  
  
  METHODS
  People with type 2 diabetes were identified using Read codes and prescribing data. Outcome measures were: glycaemic monitoring and control on multiple oral agents and/or insulin, and transition to insulin.
  
  
  RESULTS
  A total of 14 824 people with type 2 diabetes were prescribed multiple oral agents concurrently, of whom 5064 (34.16%) had haemoglobin A(1c) (HbA(1c)) assessments 6 months before and following initiation of their last oral therapy. Mean HbA(1c) before therapy was 9.07%, which dropped to 8.16% following therapy (mean difference 0.91%, 95% confidence interval [CI] = 0.86 to 0.95, P <0.0001). Of the patients with HbA(1c) assessments, 3153 (62.26%) had evidence of poor glycaemic control following therapy. Median time to insulin for patients prescribed multiple oral agents was 7.7 years (95% CI = 7.4 to 8.5 years); 1513 people began insulin during the study and had HbA(1c) assessments 6 months before and following insulin. Mean HbA(1c) before insulin was 9.85% (standard deviation [SD] 1.96%) which decreased by 1.34%, (95% CI = 1.24% to 1.44%) following therapy, but 1110 people (73.36%) still had HbA(1c) > or =7.5%.
  
  
  CONCLUSIONS
  Many people with type 2 diabetes received inadequate monitoring and had poor glycaemic control. Intensive management is required to reduce the risk of microvascular complications.
authors.affiliation: Department of Primary Care and General Practice, University of Birmingham, Birmingham. M.Calvert@bham.ac.uk
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: Calvert
authors.forename: Richard J
authors.initials: RJ
authors.lastname: McManus
authors.forename: Nick
authors.initials: N
authors.lastname: Freemantle
mesh_terms: D000368:Aged; D002983:Clinical Competence; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D003925:Diabetic Angiopathies / Q000517:prevention & control*; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D006113:United Kingdom
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin