Verschillen tussen patiënten met diabetes mellitus type 2 bij wie wel en bij wie niet wordt overgeschakeld op insulinetherapie in de tweede lijn

To describe the characteristics of patients with diabetes mellitus type 2 who were referred to an outpatient department for insulin therapy.

Setting

Hospital De Weezenlanden, Department of Internal Medicine, Zwolle, the Netherlands.

Design

Descriptive.

Method

Referred patients with diabetes mellitus type 2 visited a diabetes team consisting of internist, diabetes specialist nurse, dietician, and ophthalmologist. After maximizing oral therapy according to the dosage scheme of the national guidelines of the Dutch College of General Practitioners, patients were switched over to insulin therapy if glycaemic regulation remained poor. After improvement and stabilisation of glucose values, patients were discharged to their general practitioners. Initial baseline characteristics of those who were switched over to insulin therapy within 6 months and those who were not were compared.

Results

Forty-eight men and 51 women were included. Mean age was 61.2 years (SD: 10.9) (range: 31-84) with a mean duration of diabetes of 8.9 years (SD: 8.3). Oral hypoglycaemic agents (OHA) had been used for 6.7 years (SD: 5.4). Mean glycohaemoglobin content was 10.4 (SD: 2.7) and 47 patients had hyperglycaemic complaints at baseline. Patients switched over to insulin within six months (n = 60; 61) differed significantly from the non-insulin group (n = 38) in glycohaemoglobin (10.9 (SD: 2.5) versus 9.6 (SD: 3.0)), duration OHA use (7.7 years (SD: 5.6) versus 5.0 years (SD: 4.5)), and body mass index (26.5 kg/m² (SD: 3.9) versus 29.1 kg/m² (SD: 5.6)). In women, only the body mass index was significantly different. Main reasons for not switching over to insulin were achieving acceptable control by optimizing OHA, education by diabetes specialist nurse and dietician, treatment of underlying disease or acceptable glycohaemoglobin percentage at baseline. Within six months 62 patients (63) were discharged to their general practitioners.

Conclusion

Referral to secondary care led to improved glycaemic control through maximizing oral therapy, education by the diabetes specialist nurse and dietician, switching over to insulin and diagnosis and treatment of underlying disease.