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Mismanagement of type 2 diabetes

The result of a major 10-year study of people with type 2 diabetes in the UK has revealed that only 34% of patients were adequately monitored and 62% of patients had uncontrolled blood glucose levels (HbA1c ≥7.5) when taking two or more oral medicines.

NICE recommends that insulin should be offered to all patients whose blood glucose is inadequately controlled on oral medicines. Despite the guidance and the high level of uncontrolled patients recorded, researchers observed that only 10% of patients with evidence of poor control initiated insulin during the study.
The study involved over 62,000 people with type 2 diabetes, of which around 14,800 were taking multiple oral agents concurrently. Patients were assessed using a routine HbA1c test, which can detect whether or not blood glucose is being successfully controlled. NICE guidance recommends that people with type 2 diabetes should have their HbA1c measured every two to six months, and achieve a target HbA1c of 6.5-7.5%.
Study investigator Dr Melanie Calvert, research fellow at the Department of Primary Care and General Practice, University of Birmingham, said: "While it may be unrealistic for some patients to meet current targets, many patients appear to require more routine monitoring and intensive treatment. Changes are
needed in professional practice and interventions to help patients understand that diabetes is a progressive disease, to reduce self-blame and to understand the potential benefits from improved glycaemic control."

In the study, the average time to insulin initiation in people with type 2 diabetes prescribed two or more oral medicines was 7.7 years. This supports previous studies that have consistently demonstrated the difficultly faced in initiating insulin:

  • 57% of patients with type 2 diabetes are worried about starting insulin.
  • 27% of people with type 2 diabetes initially refused to take insulin.
  • 42% of type 1 and type 2 patients expressed concern at having to inject more frequently.
  • 50-55% of GPs and nurses postpone insulin until absolutely essential.

Studies have shown that nearly three times as many patients would choose to start insulin therapy when inhaled insulin was included as a treatment option, compared to those where subcutaneous insulin was the only treatment option.