title: Medical care of type 2 diabetes mellitus in light of international and national recommendations: a retrospective analysis.
abstract: OBJECTIVE
  Type 2 diabetes mellitus (T2Dm) is a chronic disease with great economic impact. In 2009, the Swiss Society for Endocrinology and Diabetes (SSED) published recommendations for treatment of T2Dm. In Switzerland, few data are currently available on metabolic control and physician compliance with treatment guidelines. We aimed to investigate clinical care in T2Dm in the year after the publication of SSED recommendations.
  
  
  METHODS
  We retrospectively studied the charts of all patients with T2Dm admitted to our general internal medicine clinic during 2009. Metabolic control was judged from glycated haemoglobin A1c (HbA1c) levels. Antidiabetic therapy was analysed, and frequencies of screening for end-organ damage were investigated. A group with newly diagnosed T2Dm was analysed separately from patients with known T2Dm upon admission.
  
  
  RESULTS
  In patients with known T2Dm, the mean (± standard deviation) HbA1c level was 7.66% ± 1.73%. Only 44% of patients showed HbA1c levels at the target of ≤7%. Prior to admission and at discharge, 56% and 55% of patients, respectively, were treated with metformin. Among patients with HbA1c >8.5%, the proportion of those treated with insulin increased from 49% upon admission to 76% at discharge. Only half the patients received a lifestyle intervention in the year prior to admission or during hospital stay. Screening for diabetic retinopathy and nephropathy was performed in approximately one-third and two-thirds of patients, respectively.
  
  
  CONCLUSIONS
  In the majority of unselected T2Dm patients admitted to our hospital, metabolic control was suboptimal. Implementation of treatment recommendations by both general practitioners and hospitals should be improved.
authors.affiliation: Department of Medicine, Clinic for Internal Medicine, Hospital Centre, Biel/Bienne, Switzerland; konsitt@gmx.de.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Burgmann
authors.forename: Sandra
authors.initials: S
authors.lastname: Fatio
authors.forename: Beat
authors.initials: B
authors.lastname: Jordi
authors.forename: Jonas
authors.initials: J
authors.lastname: Rutishauser
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000209:etiology; D003930:Diabetic Retinopathy / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D040242:Risk Reduction Behavior; D013557:Switzerland; D016896:Treatment Outcome
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin; C517652:hemoglobin A1c protein, human