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Diet-Managed Diabetic Patients Are Monitored Less, Have More Complications

Patients with diet-managed type 2 diabetes have substantially more risk and receive less monitoring for diabetes-related complications than their hypoglycemic-medicated counterparts, researchers report in the July 31, 2004, issue of Lancet.

Many patients with diet-managed diabetes do not take their diet seriously, according to study authors Julia Hippisley-Cox, MD, and Mike Pringle, MD, of the Division of General Practice at the University of Nottingham, U.K. The authors' focus was the high rates of diabetes-related complications found in diet-managed patients.

After scrutinizing records of 7,870 adult patients with type 2 diabetes registered with 42 general practices in the U.K., the authors found that 31% of the patients were diet-managed. Of these, nearly 68% had at least one diabetes-related complication, including vascular disease in over 59%, and diabetesrelated eye disorders in over 20%.

Compared with patients on hypoglycemic medication, dietmanaged patients were 71% less likely to have glycated hemoglobin (A1C) and 61% less likely to have serum cholesterol recorded. However, when measured, 17.3% had high A1C values (above 7.4%), and 46.7% had high serum cholesterol (above 116 mg/dl).

Diet-managed patients were also less likely to have records of body mass index, smoking status, microalbuminuria testing, foot pulses, and retinal screening, compared with medication-managed patients.

Additionally, diet-managed patients were 55% less likely to have blood pressure (BP) recorded than diabetic patients on medication. But when recorded, nearly 43% of the diet-managed patients had BP above 140/85 mmHg, and over 32% of these had not taken antihypertensive medication during the previous 6 months. When treated, diet-managed patients were more likely to have prescriptions for thiazides and less likely to be prescribed angiotensin-converting enzyme inhibitors, beta-blockers, and calcium channel blockers, than were patients with hypertension treated for hypoglycemia.

"There is clearly considerable scope for improving the care received by these patients," the authors conclude.

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Services Email this article to a friend Similar articles in this journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hendry, J. Search for Related Content PubMed Articles by Hendry, J. Social Bookmarking                What's this?