Verbetering van glykemische regulering zonder exogeen insuline bij 40% van slecht ingestelde patiënten met diabetes mellitus type 2; een onderzoek in 18 huisartspraktijken

To determine the possibility of improving glycaemic control in poorly regulated patients with type 2 diabetes mellitus (DM 2) through maximization of oral medication by the general practitioner followed by education and instruction in self-regulation by the diabetes nurse, as required.

Design

Explorative, descriptive, prospective cohort study.

Method

24 general practitioners selected all known patients with DM 2 and poor glycaemic control (HbA_1c value ≥ 8 and/or fasting blood glucose > 8 mmol/l), and maximized oral blood glucose lowering drugs if possible. When the HbA_1c level remained ≥ 8, patients were referred to the diabetes nurse.

Results

In a population of 735 patients with DM 2 treated by the general practitioner, 146 patients were poorly regulated. Out of 112 patients with sub-maximal therapy, 50 achieved an HbA_1c < 8 after adjustment of oral therapy. Of the 60 poorly regulated patients on maximum therapy, 39 were referred to the diabetes nurse. Nine of these patients subsequently achieved an HbA_1c level < 8.

Conclusion

In 40 (50+9/146) of the poorly regulated patients with DM 2, improvement of glycaemic control could be achieved through optimization of oral therapy by the general practitioner and diabetes nurse, without exogen administered insulin.