TYPE 2 DIABETES MELLITUS: HOW WELL CONTROLLED IN OUR PATIENTS?

Nasir Ahmed, Shakeel Ahmad Jadoon, Raza Muhammad Khan, Mazahar -ud- Duha, Mohammed Javed

Abstract


Background: Type 2 Diabetes mellitus has reached epidemic proportions worldwide and Pakistan is no
exception. This study was done to see the glycaemic control of our diabetic patients by estimating
Glycosylated haemoglobin & Fasting blood glucose as poor control leads to significant complications
causing enormous human suffering & socioeconomic burden. Method: This Cross-sectional study was
conducted on Type 2 diabetic patients coming to medical OPD and medical B ward of Ayub Teaching
Hospital between March–September 2007 fulfilling the inclusion criteria. Results: Among 100 patients
with type 2 diabetes forty two had HbA1c more than 7.5 %, while seventy had fasting blood glucose more
than 120 mg/dl. All patients with HbA1c more than 7.5% had increased fasting blood glucose. While thirty
out of seventy patients with fasting blood glucose more than 120 mg/dl had HbA1c less than 7.5%. None
of the patients with fasting blood glucose less than 120 mg/dl had HbA1c more than 7.5%. Conclusions:
Significant number of patients (42%) had poor control of diabetes as revealed by HbA1c, with FBG
showing poor control in even more patients, i.e., 70%. However their blood glucose estimation was not
frequent enough as required. Blood glucose results can be spuriously high and may lead to frequent
change/ increase in the dose of hypoglycaemic medications. This can lead to poor compliance as well as
psychological trauma to patients. HbA1c on the other hand is easy to interpret, reflects long term
glycaemic control and cost effective. We recommend its more frequent use along with blood glucose for
better glycaemic control and decreased chances of complications.
Keywords: Glycosylated Haemoglobin, Fasting Blood Glucose, Type 2 Diabetes mellitus

References


World health organization, Definition, diagnosis and

classification of diabetes mellitus and its complications.

Report of a WHO consultation. Part 1; Diagnosis and

classification of diabetes mellitus .Geneva; World Health

Organization, 1999.

Expert Committee on the Diagnosis and Classification of

Diabetes Mellitus. Report of the Expert Committee on the

Diagnosis and Classification of Diabetes Mellitus. Diabetes

Care. 1997;20:1183–97.

Scheen AJ, Lefebvre PJ. In; Di Mario U, Leonetti F, Pugliese

G, Sbraccia P, Signore A, eds. Diabetes in the New

Millennium New York: Wiley and sons; 2000.p 101–13.

UK Prospective Diabetes study (UKPDS) group. Intensive

blood glucose control with sulphonylureas or insulin

compared with conventional treatment and the risk of

complications in patients with type II DM (UKPDS 33)

Lancet 1998;352:837–53.

Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE,

Cull CA et al. Association of glycemia with macrovascular

and microvascular complications of type 2 diabetes (UKPDS

: prospective observational study. BMJ 2000;321:405–12.

Evans JMM, Newton RW, Ruta DA, MacDonald TM, Stevenson RJ,

Morris AD. Frequency of blood glucose monitoring in relations to

glycaemic control: observational study with diabetes database. BMJ

;319:83–6.

DCCT Research Group. The effect of intensive treatment of

diabetes on development and progression of long-term

complications in insulin dependant diabetes mellitus. N Eng

J Med 1989;329;977–86

Davis M, Day J. Screening for NIDDM; how often should it

be performed. J Med Screening. 1994;1:78–81.

American Diabetes Association. Consensus statement on self–

monitoring of blood glucose. Diabetes Care 1994;17:81–6.

Harris MI, Cowie CC, Howie LJ. Self monitoring of blood

glucose by adults with diabetes in the United States

population. Diabetes care. 1993;16:1116–23.

Peters AL, Davidson MB, Schriger DL, Hasssel Blad V. A

clinical approach for the diagnosis of diabetes mellitus ; an

analysis using glycosylated haemoglobin levels. JAMA

;1996:1246–52.

Clutter WE: Meta-analysis: glycosylated hemoglobin levels

are useful for diagnosing diabetes. ACP Jrn Club

;1997:46.

American Diabetes Association : Screening for diabetes

(position statement).Diabetes Care 2002;25(Suppl-1);S21–S24.

Alberti K, Zimmer P. Definition, diagnosis and classification

of Diabetes mellitus and its complications, part1: diagnosis

and classification of diabetes mellitus, provisional report of a

World Health Organization consultation. Diabet

Med.1998;15:539–53.

Basit A, Hakeem R. Hydrie Z I, Ahmedani Y, Masood Q.

Frequency of chronic complications of type 2 diabetes in

subjects attending a tertiary care unit in Karachi,

Pakistan.18th International Diabetes Federation Congress,

PARIS 2003;1–40.

Silverman. The Relationship of plasma Glucose and HbA1c

Levels among Emergency Department patents with no prior

history of Diabetes Mellitus. Acad Emerg Med 2006;13:722–6.

Patrick AW, Gill GV, MacFarlane IA, Cullen A, Power E,

Wallymahmed M. Home glucose monitoring in type 2 DM:

is it waste of time? Diabetic Med 1994;11:62–5.

Kilpatrick. Glycated haemoglobin in the year 2000. J Clin

Pathol 2000;53:335–9.

David MN, John BB, Mayer BD, Robert JH, Rury RH,

Robert S, Bernard Z. Management of Hyperglycemia in Type

Diabetes: A consensus algorithm for initiation and

adjustment of therapy; A consensus statement from the

American Diabetes Association and the European

Association for the Study of Diabetes. Diabetes Care

;29:1963–72.

Sacks DB, Burns DE, Goldstein DE, Maclaren NK,

McDonald JM, Parrott M. Guidelines and recommendations

for laboratory analysis in the diagnosis and management of

diabetes mellitus. Clin Chem 2002;48:436–72.


Refbacks

  • There are currently no refbacks.


Contact Number: +92-992-382571

email: [jamc] [@] [ayubmed.edu.pk]