Author(s): Fox KM, Gerber Pharmd RA, Bolinder B, Chen J, Kumar S, Fox KM, Gerber Pharmd RA, Bolinder B, Chen J, Kumar S
Abstract Share this page
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 prevalence of 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 (HbA1c): 6.5\%, 7.0\%, or 7.5\%. Values above the cutoffs indicated inadequate control of HbA1c; 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, > or =2 years of follow-up, and > or =2 HbA1c measurements during the first year. Five independent cross-sectional analyses were conducted, grouping data by year. Statistical significance was determined by Student t and chi2 tests. RESULTS: Data were analyzed for 10,663 patients aged 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/m(2). Seventy-six percent of patients had HbA1c >7.0\% and 37\% were taking > or =2 oral agents. In 1998 and 2002, 79\% (4482/5674) and 76\% (4732/6192) of patients, respectively, had inadequate glycemic control, defined as HbA1c >7.0\%. When defined as HbA1c >7.5\%, 69\% (3923/5674) and 62\% (3814/6192) of patients, respectively, had inadequate control. Finally, when defined as HbA1c >6.5\%, 88\% (5011/5674) of patients in both 1998 and 2002 had inadequate control. Compared with patients with good disease control (HbA1c < or =7.0\%), patients with inadequate control were approximately 2 years younger (P < 0.001) and had been prescribed more OAs: 41\% received > or =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 HbA1c cutoff, patients with inadequate control were younger and received prescriptions for more OAs than patients with good control.
This article was published in Clin Ther
and referenced in Journal of AIDS & Clinical Research