Prevalence of inadequate glycemic control among patients with type 2 diabetes in the United Kingdom general practice research database: A series of retrospective analyses of data from 1998 through 2002

doi:10.1016/j.clinthera.2006.03.005

Clinical Therapeutics

Volume 28, Issue 3, March 2006, Pages 388-395

https://doi.org/10.1016/j.clinthera.2006.03.005 Get rights and content

Abstract

Background:

Since the mid-1990s, the development of new oral antidiabetic agents (OAs) and treatment guidelines have created an opportunity to improve glycemic control in patients with type 2 diabetes.

Objectives:

This study aimed to assess the prevalenceof good and inadequate glycemic control across a 5-year period among patients with diabetes in the United Kingdom. It also investigated the factors associated with achieving glycemic targets.

Methods:

This was a retrospective, cross-sectional analysis of data from the General Practice Research Database. Three limits were used to assess glycosylated hemoglobin (HbA_1c): 6.5%, 7.0%, or 7.5%. Values above the cutoffs indicated inadequate control of HbA_1c; those at or below the cutoffs indicated good control. The study evaluated clinical and pharmacy data from the years 1998 to 2002 for patients with type 2 diabetes, ≥2 years of follow-up, and ≥2 HbA_1c measurements during the first year. Five independent cross-sectional analyses were conducted, grouping data by year. Statistical significance was determined by Student t and χ² tests.

Results:

Data were analyzed for 10,663 patientsaged 17 to 98 years. The number of total eligible type 2 diabetes patients increased over the course of the study period: 5674 patients in 1998, 6553 in 1999, 7314 in 2000, 7323 in 2001, and 6192 in 2002. Overall, the study population had a mean (SD) age of 66 (11.0) years, was 53% male (3033/5674), and had a body mass index of 29 kg/m². Seventy-six percent of patients had HbA_1c >7.0% and 37% were taking ≥2 oral agents. In 1998 and 2002, 79% (4482/5674) and 76% (4732/6192) of patients, respectively, had inadequate glycemic control, defined as HbA_1c >7.0%. When defined as HbA_1c >7.5%, 69% (3923/5674) and 62% (3814/6192) of patients, respectively, had inadequate control. Finally, when defined as HbA_1c >6.5%, 88% (5011/5674) of patients in both 1998 and 2002 had inadequate control. Compared with patients with good disease control (HbA_1c ≤7.0%), patients with inadequate control were ∼2 years younger (P < 0.001) and had been prescribed more OAs: 41% received ≥2 OAs in 1998 and 52% in 2002, compared with 23% and 34% (both, P = 0.001), respectively, of patients with good glycemic control (P < 0.02). Sex, number of diabetes complications, and number of comorbidities did not differ between groups (P = NS).

>Conclusions:

Despite the introduction of new OAs and treatment guidelines, the prevalence of inadequate glycemic control remains high (>60%) in patients with type 2 diabetes in the United Kingdom. Regardless of the HbA_1c cutoff, patients with inadequate control were younger and received prescriptions for more OAs than patients with good control.

References (32)

CurrieC.J. et al.
The financial costs of hospital care for people with diabetes who have single and multiple macrovascular complications
Diabetes Res Clin Pract
(2005)
LangeL.J. et al.
Perceived health status and perceived diabetes control: Psychological indicators and accuracy
J Psychosom Res
(2005)
SavocaM.R. et al.
Profiles of people with type 2 diabetes mellitus: The extremes of glycemic control
Soc Sci Med
(2004)
AlbrightE.
The diabetes epidemic
Ala Diabetes Monitor
(2002)
International Diabetes Federation
Diabetes atlas
(June 29, 2005)
American Diabetes Association
Pre-diabetes is serious, costly, and a big CVD risk
(June 11, 2005)
KleinR. et al.
Relation ofglycemic control to diabetic microvascular complications in diabetes mellitus
Ann Intern Med
(1996)
KuusistoJ. et al.
NIDDM and its metabolic control predict coronary heart disease in elderly subjects
Diabetes
(1994)
KleinR.
Hyperglycemia and microvascular and macrovascular disease in diabetes
Diabetes Care
(1995)
KhawK.T. et al.
Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of European Prospective Investigation of Cancer and Nutrition (EPIC-Norfolk)
BMJ
(2001)

KereiakesD.J.

Myocardial infarction in the diabetic patient

Clin Cardiol

(1985)

MiettinenH. et al.

Impact of diabetes on mortality after the first myocardial infarction

Diabetes Care

(1998)

McAlpineR.R. et al.

The annual incidence of diabetic complications in a popu lation of patients with type 1 and type 2 diabetes

Diabet Med

(2005)

JerumsG. et al.

Treatment of microalbuminuria in patients with type 2 diabetes mellitus

Treat Endocrinol

(2002)

WildeC.

Diabetic nephropathy-who cares?

EDTNA ERCAJ

(2004)

NathanD.M.

Clinical practice. Initial management of glycemia in type 2 diabetes mellitus

N Engl J Med

(2002)

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^*: This work was presented in part at the 65th Scientific Sessionsof the American Diabetes Association, June 10–14, 2005, San Diego, California.

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Prevalence of inadequate glycemic control among patients with type 2 diabetes in the United Kingdom general practice research database: A series of retrospective analyses of data from 1998 through 2002*

Abstract

Background:

Objectives:

Methods:

Results:

>Conclusions:

Diabetes Res Clin Pract

J Psychosom Res

Soc Sci Med

The diabetes epidemic

Ala Diabetes Monitor

Diabetes atlas

Pre-diabetes is serious, costly, and a big CVD risk

Relation ofglycemic control to diabetic microvascular complications in diabetes mellitus

Ann Intern Med

NIDDM and its metabolic control predict coronary heart disease in elderly subjects

Diabetes

Hyperglycemia and microvascular and macrovascular disease in diabetes

Diabetes Care

Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of European Prospective Investigation of Cancer and Nutrition (EPIC-Norfolk)

BMJ

Myocardial infarction in the diabetic patient

Clin Cardiol

Impact of diabetes on mortality after the first myocardial infarction

Diabetes Care

The annual incidence of diabetic complications in a popu lation of patients with type 1 and type 2 diabetes

Diabet Med

Treatment of microalbuminuria in patients with type 2 diabetes mellitus

Treat Endocrinol

Diabetic nephropathy-who cares?

EDTNA ERCAJ

Clinical practice. Initial management of glycemia in type 2 diabetes mellitus

N Engl J Med