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Diabetes control in type 2 diabetic subjects treated in primary health care--how far is from life to standards?

Diabetes control in type 2 diabetic subjects treated in primary health care--how far is from life to standards?

Przeglad Lekarski 65(6): 277-282

In Poland, as in many other countries, majority of type 2 diabetics subjects (80%) is treated by general practitioners (GPs). Aim of the study was to assess control of type 2 diabetic subjects treated by GPs in one of the big cities in Poland. Achievement of treatment goals was assessed according to recommendations of European Diabetes Policy Group (EDPG) published in 1998-1999 and used in Poland till 2004 and according to more rigorous criteria recommended in 2005 by Polish Diabetological Association (PDA). Study was conducted in 2004 year in 355 consecutive type 2 diabetic subjects coming for a visit to GPs in one of the primary health care centries. Group consisted of 205 women and 150 men, mean age 65.7 +/- 10.3 years, mean diabetes duration 9.2 +/- 7.3 years, mean BMI 29.9 +/- 4.9 kg/m2. In all patients blood pressure measurements were performed in sitting position and blood samples for HbA1c, fasting glycaemia, total cholesterol, LDL, HDL and triglicerides were taken. Mean HbA1c was 7.2 +/- 1.3%; HbA1c < or = 6.5% recommended by EDPG was found in 34,6% of patients, HbA1c < or = 6.1% recommended by PDA was achieved in 19.7% of subjects. Mean fasting glycaemia was 144 +/- 48 mg/dl; glycaemia < or = 110 mg/dl recommended by EDPG and PDA was present in 24% of patients. Dyslipidaemia was present in 62% of diabetics. Mean total cholesterol was 203.7 +/- 45 mg/dl, LDL 118 +/- 33 mg/dl, HDL 51 +/- 13 mg/dl. LDL cholesterol < 100 mg/dl recommended by EDPG and PDA was observed in 28.7% of subjects. HDL cholesterol > 46 mg/dl (EDPG criteria) was found in 61% of patients. HDL cholesterol > 40 mg/dl in men and > 50 mg/dl in women ( PDA criteria) was present 64.5% of subjects. Mean triglycerides level was 182 +/- 108 mg/dl; concentrations < 150 mg/dl (EDPG and PTD criteria) were observed in 46.2% of subjects. Hypertension was present in 81.4% of patients. Mean systolic blood pressure (SPB) was 146.1 +/- 20.4 mmHg, diastolic (DBP) 83.0 +/- 11.1 mmHg. Recommended by EDPG, SPB < 140 mmHg was observed in 47,9%, DBP < 85 mmHg--in 69.9%. Recommended by PTD, SBP < 130 mmHg was found in 16.1%, DBP < 80 mmHg--in 24.5%, and both values only in 8.2% of diabetics. All treatment goals recommended by EDPG-1998-1999 were achieved only in 2 patients. No one person achieved all goals of treatment recommended by PDA-2005. Great majority of type 2 diabetic subjects treated in primary health care failed to attain treatment goals recommended by EDPG 1998-1999 and by PDA 2005.

Accession: 052572662

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PMID: 18853658

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