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Glycaemic levels triggering intensification of therapy in type 2 diabetes in the community: the Fremantle Diabetes Study

2006; Wiley; Volume: 184; Issue: 7 Linguagem: Inglês

10.5694/j.1326-5377.2006.tb00264.x

1326-5377

Timothy M. E. Davis, Wendy A. Davis, David Bruce,

Diabetes Management and Research

Medical Journal of AustraliaVolume 184, Issue 7 p. 325-328 Research Glycaemic levels triggering intensification of therapy in type 2 diabetes in the community: the Fremantle Diabetes Study Timothy M E Davis BMedSc, MRCP, DPhil, FRACP, Corresponding Author Timothy M E Davis BMedSc, MRCP, DPhil, FRACP Professor of Medicine tdavis@cyllene.uwa.edu.au School of Medicine and Pharmacology, University of Western Australia, Fremantle, WA.Correspondence: tdavis@cyllene.uwa.edu.auSearch for more papers by this authorWendy A Davis BA(Hons), MSc, MPH, PhD, Wendy A Davis BA(Hons), MSc, MPH, PhD Research Fellow School of Medicine and Pharmacology, University of Western Australia, Fremantle, WA.Search for more papers by this authorDavid G Bruce MD, FRACP, David G Bruce MD, FRACP Associate Professor of Geriatric Medicine School of Medicine and Pharmacology, University of Western Australia, Fremantle, WA.Search for more papers by this author Timothy M E Davis BMedSc, MRCP, DPhil, FRACP, Corresponding Author Timothy M E Davis BMedSc, MRCP, DPhil, FRACP Professor of Medicine tdavis@cyllene.uwa.edu.au School of Medicine and Pharmacology, University of Western Australia, Fremantle, WA.Correspondence: tdavis@cyllene.uwa.edu.auSearch for more papers by this authorWendy A Davis BA(Hons), MSc, MPH, PhD, Wendy A Davis BA(Hons), MSc, MPH, PhD Research Fellow School of Medicine and Pharmacology, University of Western Australia, Fremantle, WA.Search for more papers by this authorDavid G Bruce MD, FRACP, David G Bruce MD, FRACP Associate Professor of Geriatric Medicine School of Medicine and Pharmacology, University of Western Australia, Fremantle, WA.Search for more papers by this author First published: 03 April 2006 https://doi.org/10.5694/j.1326-5377.2006.tb00264.xCitations: 49Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract Objective: To assess the effectiveness of the management of type 2 diabetes in an urban Australian setting. Design and setting: The Fremantle Diabetes Study (FDS), a community-based longitudinal observational study. Patients: 531 FDS participants with type 2 diabetes, with mean age, 62.4 years (95% CI, 40.9–79.3 years), 54% male, median diabetes duration 3.0 years (interquartile range [IQR], 0.7–7.0 years), with valid data from the baseline FDS assessment and five subsequent annual reviews between 1993 and 2001. Main outcome measures: Glycated haemoglobin (HbA1c) levels at annual review visits before and after change in blood glucose-lowering therapy. Results: Over 2893 patient-years of follow-up, 97 patients (18%) progressed from dietary management to therapy with oral hypoglycaemic agents (OHA), and 45 (9%) progressed from OHA to insulin therapy, after a median duration of diabetes of 4.0 years (IQR, 2.9–5.5 years) and 8.1 years (IQR, 5.5–13.0 years), respectively. Median HbA1c concentrations (IQR) at the review before OHA or insulin were started were 7.7% (6.9%–8.8%) and 9.4% (8.0%–10.7%), respectively. At the next annual review, HbA1c levels in the two groups had fallen to 7.4% (6.5%–8.1%) and 7.9% (7.2%–9.5%), respectively (P ≤ 0.001). Intensification of therapy was associated with beneficial changes in serum lipid profiles, but not with an increase in frequency of hypoglycaemia. Conclusions: Most Australian patients with type 2 diabetes may be spending most of the duration of their disease with suboptimal glycaemic control (HbA1c > 7.0%), despite the availability of a range of effective therapies, including insulin. Citing Literature Volume184, Issue7April 2006Pages 325-328 RelatedInformation