title: Adequate prescribing of medication does not necessarily translate into good control of diabetes mellitus.
abstract: BACKGROUND
  Patients with diabetes mellitus in Lithuania have access to almost all the latest blood glucose-lowering drugs available in the rest of the world. This study evaluated the effects of prescribing of treatment (oral medications, insulin, or both) in Lithuanian patients with type 1 or 2 diabetes and poor blood glucose control.
  
  
  METHODS
  The relevant information was obtained from specialized questionnaires completed by 26 consulting endocrinologists in Lithuania between October 1, 2008 and December 31, 2008. The study cohort comprised 865 randomly selected patients with diabetes mellitus and a glycosylated (HbA1c) level ≥7%. In total, there were 95 patients with type 1 diabetes and 770 with type 2 diabetes.
  
  
  RESULTS
  Linear regression for patients with type 1 diabetes revealed a weak trend towards higher doses of insulin reflecting lower HbA1c values. The mean dose of insulin in patients with type 1 diabetes before an endocrinology consultation was 57.1 ± 15.7 U/day (0.8 ± 0.2 U/kg), which increased significantly to 63.3 ± 16.5 U/day (0.9 ± 0.2 U/kg) after an endocrinology consultation (P < 0.05). Treatment prescribed for patients with type 2 diabetes depended on the duration of disease. Earlier treatment recommended for 68% of patients with type 2 diabetes was subsequently changed by the endocrinologist. Linear regression showed that the insulin dose prescribed before a specialist consultation as well as that recommended by an endocrinologist was significantly correlated with body mass index.
  
  
  CONCLUSIONS
  Appropriate prescribing of blood glucose-lowering drugs does not always translate into good metabolic control of diabetes mellitus. The mean HbA1c was 8.5% ± 1.3% in patients with type 2 diabetes treated with oral drugs alone versus 9.0% ± 1.3% in those treated with insulin alone.
authors.affiliation: Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Antanas
authors.initials: A
authors.lastname: Norkus
authors.forename: Rytas
authors.initials: R
authors.lastname: Ostrauskas
authors.forename: Rimantas
authors.initials: R
authors.lastname: Zalinkevičius
authors.forename: Lina
authors.initials: L
authors.lastname: Radzevičienė
authors.forename: Rita
authors.initials: R
authors.lastname: Sulcaite
keywords: blood glucose-lowering treatment; control; diabetes mellitus