Vol 9, No 3-4 (2008): Practical Diabetology
Research paper
Published online: 2008-07-04
Progress in treatment for type 2 diabetes mellitus based on HbA1c screening in 2002 and 2005
Diabetologia Praktyczna 2008;9(3-4):132-139.
Abstract
The number of people with diabetes mellitus gradually
increases reaching pandemic proportions. Evidence
shows the relationship between normalization of
diabetes and late complications such as macroangiopathy
- atherosclerotic lesions, or microangiopathy
- retinopathy and nephropathy. It is also well known
that tight glycemic control decreases the risk for
diabetic complications. Each 1% reduction of HbA1c,
results in a 37% decrease in risk for microangiopathy
and a 21% fall in mortality risk. Despite awareness
of diabetes consequences there is still a gap
between clinical recommendations and practice. It
is estimated that 2/3 of diabetics do not achieve the
glycemic control target levels. Studies documenting
changes in glycemic control over a longer period
of time are rare. Data on normalization of diabetes
and time trends in Poland are also lacking. The
present study was undertaken to answer the following
questions:
- has glycemic control changed from 2002 to 2005 as assessed from HbA1c levels in type 2 diabetics;
- have HbA1c levels influenced therapeutic decisionmaking in diabetological practice and how. In 2002 and 2005 patients with type 2 diabetes mellitus underwent screening. Patients with at least 5-year history of diabetes and receiving hypoglycemic agents were enrolled. Each patient in primary care underwent HbA1c measurement and a questionnaire was failled. Then the patients were referred to a diabetologists who decided about further management strategy. The present findings reveal that metabolic control in patients with type 2 diabetes mellitus for at least 5 years as assessed from HbA1c levels did not change significantly from that in 2002 and in 2005 being 7.7% on average, and more than 70% of patients are not adequately controlled. Data obtained from patients receiving insulin therapy reveal that this decision is made much too late, with HbA1c levels being 8.7%. When comparing the 2002 and 2005 data there is a trend toward deciding about initiation of insulin therapy rather than continuing ineffective treatment with oral drugs. For this reason it is necessary to undertake education and organizational changes to facilitate implementation of a model for type 2 diabetic patient care combined with glycemic control target levels as recommended by the Polish Diabetes Association.
- has glycemic control changed from 2002 to 2005 as assessed from HbA1c levels in type 2 diabetics;
- have HbA1c levels influenced therapeutic decisionmaking in diabetological practice and how. In 2002 and 2005 patients with type 2 diabetes mellitus underwent screening. Patients with at least 5-year history of diabetes and receiving hypoglycemic agents were enrolled. Each patient in primary care underwent HbA1c measurement and a questionnaire was failled. Then the patients were referred to a diabetologists who decided about further management strategy. The present findings reveal that metabolic control in patients with type 2 diabetes mellitus for at least 5 years as assessed from HbA1c levels did not change significantly from that in 2002 and in 2005 being 7.7% on average, and more than 70% of patients are not adequately controlled. Data obtained from patients receiving insulin therapy reveal that this decision is made much too late, with HbA1c levels being 8.7%. When comparing the 2002 and 2005 data there is a trend toward deciding about initiation of insulin therapy rather than continuing ineffective treatment with oral drugs. For this reason it is necessary to undertake education and organizational changes to facilitate implementation of a model for type 2 diabetic patient care combined with glycemic control target levels as recommended by the Polish Diabetes Association.
Keywords: type 2 diabetes mellitusHbA1c