Department of Diabetes and Metabolism, Barts and the London School of Medicine and Dentistry, London, UK.
Prim Care Diabetes. 2011 Dec;5(4):251-5. doi: 10.1016/j.pcd.2011.07.001. Epub 2011 Jul 22.
The aim was to determine prevalence and reasons for very poor glycaemic control (HbA1c≥10% [86 mmol/mol]) amongst people with Type 2 diabetes in an ethnically diverse urban population.
Databases of three primary health centres were searched for patients with Type 2 diabetes ≥1 year, most recent HbA1c≥10% [86 mmol/mol]. Patients were invited to explore reasons for poor glycaemic control and develop an individualised management plan. Review of glycaemic control was undertaken at 6 months.
Of a total population of 28,677, 1261 had Type 2 diabetes (4.4%). 143 (11.3%) had last recorded HbA1c≥10% [86 mmol/mol]; 128 were reviewed (46.9% South Asian). People with poorer control had longer duration of diabetes and more South Asian ethnicity. Reasons for poor glycaemic control were:
lack of titration of tablets (7.8%) or insulin (12.5%), poor concordance with medication (14.0%), insulin refusal (11.7%), side effects (16.4%); Engagement: poor concordance with lifestyle (26.5%), lack of knowledge of diabetes (14.0%), infrequent attendance at clinic (16.4%); Psychosocial/mental health: denial that diabetes was a problem (7.0%), mental health problem (9.4%), social issues (10.9%); Occupation: refusal of insulin due to occupation (1.6%); difficulty in attending reviews (5.5%). At six month review, 54.5% of patients had improved HbA1c≥1%.
Poor control affects 1 in 10 of our population. We have determined a number of factors which may explain most causes. Individualised management using care planning can significantly improve control.
旨在确定在一个种族多样化的城市人群中，2 型糖尿病患者血糖控制极差（HbA1c≥10%[86mmol/mol]）的患病率和原因。
在三个初级保健中心的数据库中搜索患有 2 型糖尿病≥1 年且最近 HbA1c≥10%[86mmol/mol]的患者。邀请患者探讨血糖控制不佳的原因，并制定个体化管理计划。在 6 个月时对血糖控制进行复查。
在总共 28677 人中，有 1261 人患有 2 型糖尿病（4.4%）。有 143 人（11.3%）最后一次记录的 HbA1c≥10%[86mmol/mol]；128 人接受了复查（46.9%为南亚裔）。血糖控制较差的患者糖尿病病程较长，南亚裔人口比例较高。血糖控制不佳的原因包括：
药物（7.8%）或胰岛素（12.5%）剂量未调整，药物治疗依从性差（14.0%），拒绝胰岛素治疗（11.7%），药物副作用（16.4%）；
生活方式不依从（26.5%），对糖尿病知识缺乏（14.0%），就诊不频繁（16.4%）；
心理社会/心理健康：否认糖尿病是个问题（7.0%），心理健康问题（9.4%），社会问题（10.9%）；
因职业原因拒绝胰岛素（1.6%），难以参加复查（5.5%）。在 6 个月的复查中，有 54.5%的患者 HbA1c≥1%得到改善。
我们的人群中有 1/10 的患者血糖控制不佳。我们已经确定了一些可能解释大多数原因的因素。使用护理计划进行个体化管理可以显著改善控制。
