title: Exploring reasons for very poor glycaemic control in patients with Type 2 diabetes.
abstract: OBJECTIVE
  The aim was to determine prevalence and reasons for very poor glycaemic control (HbA1c≥10% [86 mmol/mol]) amongst people with Type 2 diabetes in an ethnically diverse urban population.
  
  
  METHODS
  Databases of three primary health centres were searched for patients with Type 2 diabetes ≥1 year, most recent HbA1c≥10% [86 mmol/mol]. Patients were invited to explore reasons for poor glycaemic control and develop an individualised management plan. Review of glycaemic control was undertaken at 6 months.
  
  
  RESULTS
  Of a total population of 28,677, 1261 had Type 2 diabetes (4.4%). 143 (11.3%) had last recorded HbA1c≥10% [86 mmol/mol]; 128 were reviewed (46.9% South Asian). People with poorer control had longer duration of diabetes and more South Asian ethnicity. Reasons for poor glycaemic control were:
  
  
  METHODS
  lack of titration of tablets (7.8%) or insulin (12.5%), poor concordance with medication (14.0%), insulin refusal (11.7%), side effects (16.4%); Engagement: poor concordance with lifestyle (26.5%), lack of knowledge of diabetes (14.0%), infrequent attendance at clinic (16.4%); Psychosocial/mental health: denial that diabetes was a problem (7.0%), mental health problem (9.4%), social issues (10.9%); Occupation: refusal of insulin due to occupation (1.6%); difficulty in attending reviews (5.5%). At six month review, 54.5% of patients had improved HbA1c≥1%.
  
  
  CONCLUSIONS
  Poor control affects 1 in 10 of our population. We have determined a number of factors which may explain most causes. Individualised management using care planning can significantly improve control.
authors.affiliation: Department of Diabetes and Metabolism, Barts and the London School of Medicine and Dentistry, London, UK.
authors.forename: Hamida
authors.initials: H
authors.lastname: Khan
authors.forename: Shawarna S
authors.initials: SS
authors.lastname: Lasker
authors.forename: Tahseen A
authors.initials: TA
authors.lastname: Chowdhury
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology / Q000523:psychology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008019:Life Style; D008131:London / Q000453:epidemiology; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010353:Patient Education as Topic; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human